Provider Demographics
NPI:1770775066
Name:KHAVARI, KATHERINE ANN (RN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:KHAVARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2280
Mailing Address - Street 2:360 PEAK ONE DRIVE - SUITE 230
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-2280
Mailing Address - Country:US
Mailing Address - Phone:970-668-9161
Mailing Address - Fax:970-668-4115
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-2280
Practice Address - Country:US
Practice Address - Phone:970-668-9161
Practice Address - Fax:970-668-4115
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO150324163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health