Provider Demographics
NPI:1720224900
Name:MACINTOSH, KAREN C (APN, FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4248
Mailing Address - Country:US
Mailing Address - Phone:970-663-3500
Mailing Address - Fax:970-292-0898
Practice Address - Street 1:305 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4248
Practice Address - Country:US
Practice Address - Phone:970-663-3500
Practice Address - Fax:970-292-0898
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186858363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO186858OtherLICENSE - RN/NP, MEDICARE PENDING