Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 37503 | CO |
NPI | 1083683049 |
---|---|
Provider Name | Ms. Susan Elaine Henley |
First Address | Colorado Springs, CO 80907 |
Second Address | Colorado Springs, CO 80907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55200869 | (05) | CO |
G03693 | (02) |