Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 83962 | CO |
NPI | 1003054859 |
---|---|
Provider Name | Ms. Kathleen Rye |
First Address | Basalt, CO 81621-3768 |
Second Address | Basalt, CO 81621-9106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 02/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MM0491679 | DEA (01) |