Kimberly Marie Wassenaar, RT(R), RPA/RA

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

License

326783/07CO 1317 Issued in CO

Practice address

2821 Willow Tree LN
Unit D
Fort Collins, CO 80525-4785

Phone

(970) 420-1679

NPI assigned

Jul 27, 2007

Last updated

Jul 27, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kimberly Marie Wolf Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185494400000",
    "number": "1932399714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 WILLOW TREE LN",
            "address_2": "UNIT D",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254785",
            "telephone_number": "970-420-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 WILLOW TREE LN",
            "address_2": "UNIT D",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254785",
            "telephone_number": "970-420-1679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSENAAR",
        "first_name": "KIMBERLY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RT(R), RPA/RA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2007-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "CO",
            "license": "326783/07CO 1317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WOLF",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "RT(R), RPA/RA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James Stickney Warson, MD
• Kayla Lee Washa, MS CCC-SLP
• Jennifer Washburn, PHARMD
• Dion Blake Washington
• Rebecca Wasno, RN
• Kenneth S Watanabe, M.D.
• Amanda Waters, LMFT
• Joan Delyse Waters, ND
• Waterstone Medical LLC
• Janell Watkins

• Radiologic Technologist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Radiologic Technologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.