Healthcare Provider Details

I. General information

NPI: 1700287976
Provider Name (Legal Business Name): KARA ROSE POLLACK AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5075 LINCOLN ST
DENVER CO
80216-2015
US

IV. Provider business mailing address

1975 GRANT ST 414
DENVER CO
80203-1127
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-5302
  • Fax: 303-433-7452
Mailing address:
  • Phone: 512-968-7539
  • Fax: 303-433-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0991410-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: