Provider Demographics
NPI:1205377611
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:BRITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTZOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-459-9106
Mailing Address - Street 1:965 N HUMBOLDT ST
Mailing Address - Street 2:APT 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:965 N HUMBOLDT ST
Practice Address - Street 2:APT 201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3563
Practice Address - Country:US
Practice Address - Phone:484-459-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center