Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 78343 | CO |
NPI | 1023266434 |
---|---|
Provider Name | Mrs. Annelle Marie Fahlsing |
First Address | Morrison, CO 80465 |
Second Address | Wheat Ridge, CO 80033-6005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |