Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 904737 | CO |
NPI | 1073813622 |
---|---|
Provider Name | Ms. Cheryl R. Redmond |
First Address | Loveland, CO 80537-3956 |
Second Address | Loveland, CO 80537-3956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2010 |
Last Update Date | 04/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21721271 | (05) | CO |