1891360558 NPI number — CAMMIE ANN SANGEET KLEINZ APRN, PMHNP-BC

Table of content: CAMMIE ANN SANGEET KLEINZ APRN, PMHNP-BC (NPI 1891360558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891360558 NPI number — CAMMIE ANN SANGEET KLEINZ APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINZ
Provider First Name:
CAMMIE ANN
Provider Middle Name:
SANGEET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, PMHNP-BC
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:
1891360558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3749 W UNION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80236-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-347-0967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4729 OPUS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906-8694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-289-3173
Provider Business Practice Location Address Fax Number:
866-718-1677
Provider Enumeration Date:
05/25/2021

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: 363LP0808X , with the licence number:  C-RXN.0001430-C-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: C-APN.0002923-C-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: 1034797 . This is a "PMHNP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 757595 . This is a "RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: C-APN.0002923-C-NP . This is a "APN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: C-RXN.0001430-C-NP . This is a "CRX" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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