Healthcare Provider Details

I. General information

NPI: 1265026132
Provider Name (Legal Business Name): LINNEA KISSEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5886 BARKELEY AVE, BUILDING 1150
FORT CARSON CO
80913
US

IV. Provider business mailing address

5886 BARKELEY AVE, BUILDING 1150
FORT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-4377
  • Fax:
Mailing address:
  • Phone: 719-526-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00150066
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00150066
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: