Provider Demographics
NPI:1760935647
Name:PICCOLO, KATIE (CLD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 ALEXANDER CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2202
Mailing Address - Country:US
Mailing Address - Phone:970-333-5060
Mailing Address - Fax:
Practice Address - Street 1:2732 ALEXANDER CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2202
Practice Address - Country:US
Practice Address - Phone:970-333-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula