Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 103741 | CO |
NPI | 1508076837 |
---|---|
Provider Name | Mrs. Terrie Lee Enriquez |
First Address | Fort Collins, CO 80526-4133 |
Second Address | Fort Collins, CO 80524-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07037419 | (05) | CO |