Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 125061880 | IL |
Y | 2084N0400X | Neurologist | DR.0053665 | CO |
NPI | 1043538085 |
---|---|
Provider Name | Susan Patrice Anzalone |
First Address | Denver, CO 80222-4353 |
Second Address | Denver, CO 80222-4353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2010 |
Last Update Date | 31/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17755212 | (05) | CO |
438126ZJUR | MEDICARE (01) | CO |