Healthcare Provider Details

I. General information

NPI: 1093619421
Provider Name (Legal Business Name): KARLIE MARIE SUPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10190 E MONTVIEW BLVD
AURORA CO
80010-2202
US

IV. Provider business mailing address

825 DAHLIA ST APT 608
DENVER CO
80220-4228
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-4242
  • Fax:
Mailing address:
  • Phone: 913-909-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: