Healthcare Provider Details

I. General information

NPI: 1588622062
Provider Name (Legal Business Name): KIMBERLY D NORDSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL FL 2
AURORA CO
80045-2570
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1000
  • Fax: 303-724-9472
Mailing address:
  • Phone: 970-624-4036
  • Fax: 970-490-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42837
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: