Provider Demographics
NPI:1982606521
Name:HINE, KAREN BREUNIG (CNS, RXN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BREUNIG
Last Name:HINE
Suffix:
Gender:F
Credentials:CNS, RXN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:BREUNIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS, RXN
Mailing Address - Street 1:1333 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2226
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:303-449-6029
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:303-449-6029
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54683363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0590807OtherDEA CERTIFICATE