Individual
NGA MEH I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 N 17TH AVE, GREELEY, CO 80631-9584
(970) 347-2120
Mailing address
1300 N 17TH AVE, GREELEY, CO 80631-9584
(970) 347-2120
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
0342734
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0342734
—
CO
Enumeration date
10/31/2016
Last updated
10/31/2016
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