Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 0056997 | CO |
NPI | 1063775005 |
---|---|
Provider Name | Teresa Cushman |
First Address | Wheat Ridge, CO 80033-4800 |
Second Address | Wheat Ridge, CO 80033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 06/03/2020 |