Healthcare Provider Details

I. General information

NPI: 1396077384
Provider Name (Legal Business Name): KRISTEN DORAK VIEHMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5351 S ROSLYN ST STE 200
GREENWOOD VILLAGE CO
80111-2132
US

IV. Provider business mailing address

5351 S ROSLYN ST STE 200
GREENWOOD VILLAGE CO
80111-2132
US

V. Phone/Fax

Practice location:
  • Phone: 303-469-3182
  • Fax: 303-469-4693
Mailing address:
  • Phone: 303-469-3182
  • Fax: 303-469-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0004135
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3406
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: