Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP-990117 | CO |
NPI | 1023320215 |
---|---|
Provider Name | Mr. Adam Russell |
First Address | Denver, CO 80206-5418 |
Second Address | Denver, CO 80211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2010 |
Last Update Date | 04/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06122388 | (05) | CO |