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General NPI Number Information
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NPI Number | 1801878434
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Entity Type | Individual
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Provider Name | KRISTIN VAN KONYNENBURG M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 600 S AIRPORT RD UNIT A203
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City | LONGMONT
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State | CO
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Zip | 80503-6427
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Country | US
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Telephone | 303-776-0467
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Fax | 303-776-0387
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Provider Business Mailing Address
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Address Line | 1067 S HOVER ST UNIT E
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City | LONGMONT
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State | CO
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Zip | 80501-7904
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Country | US
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Telephone | 720-253-5648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 42439
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License Number State | CO
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