Provider Demographics
NPI:1003033499
Name:PETERSEN, KAREN (SA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 W 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1319
Mailing Address - Country:US
Mailing Address - Phone:303-916-9447
Mailing Address - Fax:303-831-8404
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:3150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-8400
Practice Address - Fax:303-831-8404
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83249246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist