Provider Demographics
NPI:1780693721
Name:HOLEN, KATHLEEN ANN (CNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:HOLEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 PIERCE STREET
Mailing Address - Street 2:BOX 452
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516
Mailing Address - Country:US
Mailing Address - Phone:303-828-0215
Mailing Address - Fax:303-327-1188
Practice Address - Street 1:550 THORNTON PKWY
Practice Address - Street 2:SUITE 240 C
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-327-1189
Practice Address - Fax:303-327-1188
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160790363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47101Medicare UPIN