Provider Demographics
NPI:1285988618
Name:FUNDALINSKI, KATHLEEN JEANETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JEANETTE
Last Name:FUNDALINSKI
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-495-8369
Mailing Address - Fax:970-495-7492
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-8369
Practice Address - Fax:970-495-7492
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2015-12-08
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0990530-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70331570Medicaid
COPENDINGMedicare PIN