Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN.0993640-NP | CO |
NPI | 1003324245 |
---|---|
Provider Name | Sarah Elizabeth Wilson |
First Address | Denver, CO 80218-3611 |
Second Address | Broomfield, CO 80023-9511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2018 |
Last Update Date | 22/01/2018 |