Provider Demographics
NPI:1275363764
Name:ECKSTADT, KATHRINE (DNP)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:ECKSTADT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:THIBODEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:41346 PINE MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4594
Mailing Address - Country:US
Mailing Address - Phone:720-692-6800
Mailing Address - Fax:
Practice Address - Street 1:41346 PINE MEADOW CIR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-4594
Practice Address - Country:US
Practice Address - Phone:720-692-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998512-NP163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology