Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000904276 | CO |
NPI | 1023404399 |
---|---|
Provider Name | Shannon Rolf |
First Address | Colorado Springs, CO 80909-2884 |
Second Address | Colorado Springs, CO 80909-2884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 13/04/2015 |