Provider Demographics
NPI:1619369402
Name:STENSLAND, KATHERINE MICHELLE (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:STENSLAND
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:550 W HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9122
Mailing Address - Country:US
Mailing Address - Phone:719-488-9860
Mailing Address - Fax:719-488-9868
Practice Address - Street 1:550 W HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9122
Practice Address - Country:US
Practice Address - Phone:719-488-9860
Practice Address - Fax:719-488-9868
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004175363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical