Healthcare Provider Details

I. General information

NPI: 1306292511
Provider Name (Legal Business Name): ROBIN KOTULA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN SIDER NP

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 BENT WAY
LONGMONT CO
80503
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.00992016-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: