Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 6554 | CO |
Y | 111NN1001X | Nutrition | 6554 | CO |
NPI | 1952602310 |
---|---|
Provider Name | Nathan Kennedy |
First Address | Denver, CO 80206-5011 |
Second Address | Denver, CO 80206-5011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2010 |
Last Update Date | 16/11/2010 |