Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 61146 | KS |
N | 122300000X | Dentist | DE60310664 | WA |
Y | 122300000X | Dentist | DEN00009208 | CO |
N | 122400000X | Denturist | DD3822 | NM |
NPI | 1851476089 |
---|---|
Provider Name | Rebecca Suzanne Misner |
First Address | Colorado Springs, CO 80909-8009 |
Second Address | Aurora, CO 80012-3746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185147089 | (05) | WA |
1851476089 | (05) | CO |
20113080A | (05) | KS |
85752011 | (05) | NM |