Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 105635 | CO |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 105635 | CO |
NPI | 1073732335 |
---|---|
Provider Name | Ms. Judith Ann Eldred Chandler |
First Address | Colorado Springs, CO 80905-1356 |
Second Address | Colorado Springs, CO 80917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 19/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q08697 | (02) |