Provider Demographics
NPI:1295349462
Name:PEDERSEN, KATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 HOOKER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3241
Mailing Address - Country:US
Mailing Address - Phone:520-991-2923
Mailing Address - Fax:
Practice Address - Street 1:3827 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3339
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.09955986-NP363LF0000X
COAPN.0995586-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily