Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | R22496 | NM |
Y | 363L00000X | Nurse Practitioner | 20016 | CO |
N | 363L00000X | Nurse Practitioner | CNP00382 | NM |
NPI | 1033203401 |
---|---|
Provider Name | Ms. Ellen W Call |
First Address | La Jara, CO 81140-0639 |
Second Address | La Jara, CO 81140-0639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000Z5375 | (05) | NM |
78221030 | (05) | CO |
S82015 | (02) |