Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 115 | CO |
NPI | 1144552480 |
---|---|
Provider Name | Sharon Camiray Mcdougal |
First Address | Pueblo West, CO 81007-0573 |
Second Address | Pueblo West, CO 81007-1154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2010 |
Last Update Date | 03/02/2011 |