Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ANP.0994835-NP | CO |
NPI | 1073167870 |
---|---|
Provider Name | Shannon Williamson |
First Address | Evergreen, CO 80439-4924 |
Second Address | Wheat Ridge, CO 80033-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 30/07/2019 |