Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 67336 | CO |
NPI | 1407870918 |
---|---|
Provider Name | Susan L Holligan |
First Address | Denver, CO 80204-4507 |
Second Address | Denver, CO 80204-4507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48458741 | (05) | CO |