Provider Demographics
NPI:1588622062
Name:NORDSTROM, KIMBERLY D (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4036
Mailing Address - Fax:970-490-4378
Practice Address - Street 1:13001 E 17TH PL FL 2
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2570
Practice Address - Country:US
Practice Address - Phone:303-724-1000
Practice Address - Fax:303-724-9472
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO428372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58806067Medicaid
COI19729Medicare UPIN
CO804329Medicare PIN