Provider Demographics
NPI:1295879096
Name:RUNDLE, KIMBERLY R (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:RUNDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E 20TH AVE
Mailing Address - Street 2:2ND FLOOR PEDIATRICS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5423
Mailing Address - Country:US
Mailing Address - Phone:303-764-4965
Mailing Address - Fax:303-861-3667
Practice Address - Street 1:1375 E 20TH AVE
Practice Address - Street 2:2ND FLOOR PEDIATRICS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5423
Practice Address - Country:US
Practice Address - Phone:303-861-3566
Practice Address - Fax:303-861-3681
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83025163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
007478OtherKAISER-COMMERCIAL NUMBER