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NPI Code Detail

MEDICARE: MARY AVILA NP

MEDICARE: MARY AVILA NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPN.1000488-NPCO

General Provider Information

NPI Number : 1013720853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY AVILA NP
Provider Business Mailing Address
First Line : 3920 N UNION BLVD STE 150
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-1907
Country : US
Telephone Number : 719-694-3595
Fax Number : 719-493-9936
Provider Business Practice Location Address
First Line : 3920 N UNION BLVD STE 150
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-1907
Country : US
Telephone Number : 719-694-3595
Fax Number : 719-493-9936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2025
Last Update Date : 05/05/2026

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