Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5381 | CO |
NPI | 1013116318 |
---|---|
Provider Name | Mrs. Stacey Renee Smith-Bradfield |
First Address | Golden, CO 80403-7445 |
Second Address | Golden, CO 80403-7445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 15/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164202 | RN NUMBER (01) | CO |