Provider Demographics
NPI:1619379419
Name:PETERSON, KRISTEN M (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5268 S ESPANA CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3704
Mailing Address - Country:US
Mailing Address - Phone:303-854-8808
Mailing Address - Fax:
Practice Address - Street 1:5268 S ESPANA CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3704
Practice Address - Country:US
Practice Address - Phone:303-854-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189196163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse