Basic Information
| Provider Information | |||||||||
| NPI: | 1649436593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAISER PERMANENTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10816 BAYFIELD WAY | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801383808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037489034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10065 E HARVARD AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802315943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036141493 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | MIA | ||||||||
| AuthorizedOfficialMiddleName: | SHEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PRACTICAL NURSE | ||||||||
| AuthorizedOfficialTelephone: | 3037489034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 32620 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.