Healthcare Provider Details

I. General information

NPI: 1083829543
Provider Name (Legal Business Name): DONNA C KAUTZMAN RN, ND, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 BLUE CREEK RD
EVERGREEN CO
80439-6347
US

IV. Provider business mailing address

PO BOX 2433
EVERGREEN CO
80437-2433
US

V. Phone/Fax

Practice location:
  • Phone: 303-520-7300
  • Fax:
Mailing address:
  • Phone: 303-520-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number122781
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: