Provider Demographics
NPI:1366728248
Name:LENDERTS, KIMBERLY A (CPM, RM, CLC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:LENDERTS
Suffix:
Gender:F
Credentials:CPM, RM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WAGONWHEEL CT
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2635
Mailing Address - Country:US
Mailing Address - Phone:970-214-1457
Mailing Address - Fax:970-225-0828
Practice Address - Street 1:2900 WAGONWHEEL CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2635
Practice Address - Country:US
Practice Address - Phone:970-214-1457
Practice Address - Fax:970-225-0828
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMWR 0000132OtherDEPARTMENT OF REGULATORY AGENCIES, DIVISION OF PROFESSIONS AND OCCUPATIONS