Provider Demographics
NPI:1851845101
Name:SVOBODA, KARLIE NICOLE
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:NICOLE
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:NICOLE
Other - Last Name:HASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2204 CUPOLA DRIVE
Mailing Address - Street 2:UNIT 207
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8553
Mailing Address - Country:US
Mailing Address - Phone:970-449-3903
Mailing Address - Fax:
Practice Address - Street 1:2204 CUPOLA DRIVE
Practice Address - Street 2:UNIT 207
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8553
Practice Address - Country:US
Practice Address - Phone:970-449-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program