Provider Demographics
NPI:1770627572
Name:WHITSEL, KATHLEEN M (RN-BSN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WHITSEL
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:PRABODHI
Other - Middle Name:
Other - Last Name:WHITSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:545 NIGHTSHADE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9211
Mailing Address - Country:US
Mailing Address - Phone:303-258-0672
Mailing Address - Fax:
Practice Address - Street 1:10065 E HARVARD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5968
Practice Address - Country:US
Practice Address - Phone:303-457-6151
Practice Address - Fax:303-457-6256
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
007265OtherKAISER-COMMERCIAL NUMBER