Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0994847-NP | CO |
NPI | 1013573997 |
---|---|
Provider Name | Kaitlyn Elizabeth Runnels |
First Address | Greeley, CO 80631-5199 |
Second Address | Greeley, CO 80631-5199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2019 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0994847-NP | APN LICENSE (01) | CO |
1013573997 | (05) | CO |
1617123 | RN LICENSE (01) | CO |