Basic Information
Provider Information | |||||||||
NPI: | 1609393560 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VANDERVELDE | ||||||||
FirstName: | KARIN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RNC CNM WHNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HEDEGAARD | ||||||||
OtherFirstName: | KARIN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2241 7TH STREET | ||||||||
Address2: | BLOOMIN' BABIES BIRTH CENTER | ||||||||
City: | GRAND JUNCTION | ||||||||
State: | CO | ||||||||
PostalCode: | 81501 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9705491711 | ||||||||
FaxNumber: | 9703142633 | ||||||||
Practice Location | |||||||||
Address1: | 2241 7TH STREET | ||||||||
Address2: | BLOOMIN' BABIES BIRTH CENTER | ||||||||
City: | GRAND JUNCTION | ||||||||
State: | CO | ||||||||
PostalCode: | 81501 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9705491711 | ||||||||
FaxNumber: | 9703142633 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2017 | ||||||||
LastUpdateDate: | 10/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | APN.0993232-CNM | CO | Y |   | Other Service Providers | Midwife |   |
No ID Information.