Provider Demographics
NPI:1316640824
Name:IENGO, KATY (CRD)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:IENGO
Suffix:
Gender:F
Credentials:CRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 RIVERSIDE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4377
Mailing Address - Country:US
Mailing Address - Phone:970-821-5728
Mailing Address - Fax:
Practice Address - Street 1:1419 RIVERSIDE AVE STE C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4377
Practice Address - Country:US
Practice Address - Phone:970-821-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula