Provider Demographics
NPI:1760813067
Name:DWORAK, KATHLEEN G (NP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:DWORAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:G
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4751
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:4743 ARAPAHOE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1128
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0127049163W00000X
COAPN.0990807-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse