Provider Demographics
NPI:1588808695
Name:KLOTZ, CHRISTINA RENE' (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RENE'
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIM DR 170 SKYHAWK STATION
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3999
Mailing Address - Country:US
Mailing Address - Phone:970-247-7355
Mailing Address - Fax:970-564-8833
Practice Address - Street 1:1000 RIM DR 170 SKYHAWK STATION
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3999
Practice Address - Country:US
Practice Address - Phone:970-247-7355
Practice Address - Fax:970-247-7621
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-6014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52925251Medicaid
CO52925251Medicaid