Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 48291 | CO |
NPI | 1053638064 |
---|---|
Provider Name | Mollie T Miller |
First Address | Denver, CO 80291-1057 |
Second Address | Canon City, CO 81212-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48291 | STATE LICENSE (01) | CO |