Basic Information
| Provider Information | |||||||||
| NPI: | 1801026992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENAN | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KEACHIE | ||||||||
| OtherFirstName: | KRISTA | ||||||||
| OtherMiddleName: | N | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244034 | ||||||||
| FaxNumber: | 9704904347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 E BOULDER ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809095740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656300 | ||||||||
| FaxNumber: | 7193656094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | A113957 | CA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207T00000X | DR.0061162 | CO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.