Provider Demographics
NPI:1487198529
Name:WALTZMAN, CARRIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WALTZMAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6162 S. WILLOW DR.
Mailing Address - Street 2:100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-220-9200
Mailing Address - Fax:303-741-4173
Practice Address - Street 1:6162 S. WILLOW DR.
Practice Address - Street 2:100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-220-9200
Practice Address - Fax:303-741-4173
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1628457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse