Basic Information
| Provider Information | |||||||||
| NPI: | 1275769325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZYBACH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STURGEON | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9224 TEDDY LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801246798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037901515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2643 PATTERSON RD STE 603 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702987440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2012020840 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 4301094205 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | DR0055909 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.