Healthcare Provider Details

I. General information

NPI: 1386920254
Provider Name (Legal Business Name): KARI L WADDELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE. SUITE 200
BOULDER CO
80303
US

IV. Provider business mailing address

4745 ARAPAHOE AVE. SUITE 200
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-4750
  • Fax:
Mailing address:
  • Phone: 303-938-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201558
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number990253
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: