Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 41047 | CO |
NPI | 1285635193 |
---|---|
Provider Name | Susan Wonsiewicz Trout |
First Address | Denver, CO 80220-4020 |
Second Address | Denver, CO 80220-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F90119 | (02) |