Healthcare Provider Details

I. General information

NPI: 1316169014
Provider Name (Legal Business Name): PATRICIA ANN KINTZING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WARDENBURG HEALTH CTR 119UCB
BOULDER CO
80309-0119
US

IV. Provider business mailing address

4528 7TH ST
BOULDER CO
80304-4394
US

V. Phone/Fax

Practice location:
  • Phone: 303-735-0678
  • Fax:
Mailing address:
  • Phone: 303-546-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number167802
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: