Provider Demographics
NPI:1841380854
Name:KWERNELAND, CAROLYN MURRAY (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MURRAY
Last Name:KWERNELAND
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 1:6029 W ROXBURY PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4639
Mailing Address - Country:US
Mailing Address - Phone:303-973-5929
Mailing Address - Fax:
Practice Address - Street 1:260 S. KIPLING ST.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1099
Practice Address - Country:US
Practice Address - Phone:303-239-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71202163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07712029Medicaid