Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 100562 | CO |
NPI | 1174742886 |
---|---|
Provider Name | Mrs. Martha Wiley Trower |
First Address | Evergreen, CO 80439-4318 |
Second Address | Thornton, CO 80229-4361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 01/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100562 | (05) | CO |