Healthcare Provider Details

I. General information

NPI: 1265799837
Provider Name (Legal Business Name): KATHERINE CASHMAN PORTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PROFESSIONAL LN UNIT 290
LONGMONT CO
80501-6970
US

IV. Provider business mailing address

1615 TURIN DR
LONGMONT CO
80503-2717
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-5000
  • Fax:
Mailing address:
  • Phone: 720-713-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number259310
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0992773
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209009407
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: