Provider Demographics
NPI:1285385997
Name:VANOTTERLOO, KAREN (RN)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:VANOTTERLOO
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 1:5116 BUCKWHEAT RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-9670
Mailing Address - Country:US
Mailing Address - Phone:720-352-3553
Mailing Address - Fax:
Practice Address - Street 1:5116 BUCKWHEAT RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80640-9670
Practice Address - Country:US
Practice Address - Phone:720-352-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0192773163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty