Provider Demographics
NPI:1144743949
Name:MUND-WOLKENBREIT, KIMBERLY (RN,IBCLC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MUND-WOLKENBREIT
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E 1ST ST STE 137
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2804
Mailing Address - Country:US
Mailing Address - Phone:970-409-8884
Mailing Address - Fax:
Practice Address - Street 1:448 E 1ST ST STE 137
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2804
Practice Address - Country:US
Practice Address - Phone:719-293-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0124448163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO601802330Medicaid