1548776719 NPI number — MRS. KRISTA MARIE WILLMANN MSN, APRN, FNP-C

Table of content: MRS. KRISTA MARIE WILLMANN MSN, APRN, FNP-C (NPI 1548776719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548776719 NPI number — MRS. KRISTA MARIE WILLMANN MSN, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLMANN
Provider First Name:
KRISTA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548776719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9313 W RADCLIFFE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80123-1196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-475-3237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10103 RIDGEGATE PKWY STE G21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-792-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  09983579-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1640585 . This is a "COLORADO STATE BOARD OF NURSING RN LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 0993579-NP . This is a "COLORADO SATE BOARD OF NURSING NURSE PRACTITIONER-APN LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: F10170783 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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