Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 47730 | CO |
Y | 208600000X | Surgeon | 47730 | CO |
N | 208200000X | Surgeon | A82127 | CA |
N | 208600000X | Surgeon | A82127 | CA |
N | 208200000X | Surgeon | MD2009-0509 | NM |
N | 208600000X | Surgeon | MD2009-0509 | NM |
N | 2086X0206X | Surgical Oncologist | 51301 | MN |
NPI | 1427039908 |
---|---|
Provider Name | Kimberly Vanderveen |
First Address | Denver, CO 80220-3911 |
Second Address | Denver, CO 80220-3911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |
RES000 | (02) | CA |