Healthcare Provider Details

I. General information

NPI: 1609150218
Provider Name (Legal Business Name): KRISTINA RENEE GUTZMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 55TH ST STE 123
BOULDER CO
80303-1256
US

IV. Provider business mailing address

1530 55TH ST STE 123
BOULDER CO
80303-1256
US

V. Phone/Fax

Practice location:
  • Phone: 720-477-6699
  • Fax: 833-973-4351
Mailing address:
  • Phone: 720-477-6699
  • Fax: 833-973-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0996848-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0106889
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0996848-NP
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1174398515
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerNPI GROUP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: