Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 128352 | CO |
NPI | 1194774679 |
---|---|
Provider Name | Mrs. Carol Lynnette Beck |
First Address | Fort Collins, CO 80528-9461 |
Second Address | Englewood, CO 80113-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |