Provider Demographics
NPI:1699109397
Name:ARNOLD, KATRINA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4830
Mailing Address - Country:US
Mailing Address - Phone:303-245-0123
Mailing Address - Fax:303-245-0119
Practice Address - Street 1:1317 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4830
Practice Address - Country:US
Practice Address - Phone:303-245-0123
Practice Address - Fax:303-245-0119
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0048224164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse