Healthcare Provider Details

I. General information

NPI: 1619379419
Provider Name (Legal Business Name): KRISTEN M PETERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN M WITT RN

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 S ESPANA CIR
CENTENNIAL CO
80015-3704
US

IV. Provider business mailing address

5268 S ESPANA CIR
CENTENNIAL CO
80015-3704
US

V. Phone/Fax

Practice location:
  • Phone: 303-854-8808
  • Fax:
Mailing address:
  • Phone: 303-854-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189196
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: