Healthcare Provider Details

I. General information

NPI: 1003033499
Provider Name (Legal Business Name): KAREN PETERSEN S.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE 3150
DENVER CO
80218-1216
US

IV. Provider business mailing address

3515 W 45TH AVE
DENVER CO
80211-1319
US

V. Phone/Fax

Practice location:
  • Phone: 303-831-8400
  • Fax: 303-831-8404
Mailing address:
  • Phone: 303-916-9447
  • Fax: 303-831-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number83249
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: