Provider Demographics
NPI:1730249103
Name:VORDERBERG, KAREN L (CNM)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:VORDERBERG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:KENDREGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1715 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7989
Mailing Address - Country:US
Mailing Address - Phone:970-336-1500
Mailing Address - Fax:970-336-1505
Practice Address - Street 1:1715 61ST AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7989
Practice Address - Country:US
Practice Address - Phone:970-336-1500
Practice Address - Fax:970-336-1505
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV101176B00000X
CORN.0183477163W00000X
COAPN.0005437-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160157000Medicaid
CO25956248Medicaid
CO25956248Medicaid
COCO304616Medicare PIN
COCO306900Medicare PIN
WVVONM00582Medicare PIN