Individual
MRS. MARGO C BOATNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2180
COLORADO STATE LICENSE
—
05
—
72436069
—
CO
Enumeration date
03/29/2006
Last updated
03/07/2023
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