Basic Information
| Provider Information | |||||||||
| NPI: | 1093156770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELTZER | ||||||||
| FirstName: | KAITLYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 W DRY CREEK CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801204485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039536767 | ||||||||
| FaxNumber: | 3039537694 | ||||||||
| Practice Location | |||||||||
| Address1: | 28300 ORCHARD LAKE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487374030 | ||||||||
| FaxNumber: | 2487370636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0995817 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2013007118 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1780635904 | 05 | CO | MEDICAID |