Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2366 | CO |
NPI | 1073793485 |
---|---|
Provider Name | Ms. Dianne May Whittemore Anderson |
First Address | Paonia, CO 81428 |
Second Address | Paonia, CO 81428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 14/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337245 | (05) | CO |
841439569002 | ROCKY MTN HEALTH PLANS (01) | CO |