Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | ||
Y | 124Q00000X | Dental Hygienist | 906416 | CO |
NPI | 1043642374 |
---|---|
Provider Name | Stephanie Olsen |
First Address | Colorado Springs, CO 80906 |
Second Address | Colorado Springs, CO 80906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2013 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49507273 | (05) | CO |