Healthcare Provider Details

I. General information

NPI: 1710429782
Provider Name (Legal Business Name): KAREN KJORNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 W COLORADO AVE
COLORADO SPRINGS CO
80904-1916
US

IV. Provider business mailing address

3704 W COLORADO AVE
COLORADO SPRINGS CO
80904-1916
US

V. Phone/Fax

Practice location:
  • Phone: 701-306-9574
  • Fax:
Mailing address:
  • Phone: 701-306-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: