Provider Demographics
NPI:1083829543
Name:KAUTZMAN, DONNA C (RN, ND, CNS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:KAUTZMAN
Suffix:
Gender:F
Credentials:RN, ND, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-2433
Mailing Address - Country:US
Mailing Address - Phone:303-520-7300
Mailing Address - Fax:
Practice Address - Street 1:8830 BLUE CREEK RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-6347
Practice Address - Country:US
Practice Address - Phone:303-520-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO122781364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult