Provider Demographics
NPI:1255148151
Name:HALVERSTADT, KATIE ANNE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANNE
Last Name:HALVERSTADT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 W 87TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1243
Mailing Address - Country:US
Mailing Address - Phone:720-277-6901
Mailing Address - Fax:
Practice Address - Street 1:4450 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-9123
Practice Address - Country:US
Practice Address - Phone:877-593-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0198832163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant