Healthcare Provider Details

I. General information

NPI: 1417452533
Provider Name (Legal Business Name): KATHERINE ALICE SOMODI-STEPHENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ALICE SOMODI

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

1107 S LEMAY AVE STE 300
FORT COLLINS CO
80524-3955
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7442
  • Fax: 970-493-2990
Mailing address:
  • Phone: 970-493-7442
  • Fax: 970-493-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number67912
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: