Provider Demographics
NPI:1730885245
Name:WALUSIAK, KATHERINE ASHLEY (NP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ASHLEY
Last Name:WALUSIAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 SAXTON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-7208
Mailing Address - Country:US
Mailing Address - Phone:847-849-6882
Mailing Address - Fax:
Practice Address - Street 1:9362 GRAND CORDERA PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7009
Practice Address - Country:US
Practice Address - Phone:719-550-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998424-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner