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NPI Code Detail

MEDICARE: KATY IENGO CRD

MEDICARE: KATY IENGO CRD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374J00000XDoula

General Provider Information

NPI Number : 1316640824
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATY IENGO CRD
Provider Business Mailing Address
First Line : 1419 RIVERSIDE AVE STE C
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4377
Country : US
Telephone Number : 970-821-5728
Fax Number :
Provider Business Practice Location Address
First Line : 1419 RIVERSIDE AVE STE C
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4377
Country : US
Telephone Number : 970-821-5728
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2023
Last Update Date : 09/17/2024

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Directions to “ KATY IENGO CRD” Practice Location

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