Healthcare Provider Details

I. General information

NPI: 1013047869
Provider Name (Legal Business Name): KARA A MCILWAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

935 COREY ST
LONGMONT CO
80501-4526
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-7200
  • Fax:
Mailing address:
  • Phone: 303-678-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number130660
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: