Healthcare Provider Details

I. General information

NPI: 1952122376
Provider Name (Legal Business Name): MARLYSE JOY RAPPOPORT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S BLACKHAWK ST
AURORA CO
80014-1418
US

IV. Provider business mailing address

1335 WALTERS PT
MONUMENT CO
80132-8633
US

V. Phone/Fax

Practice location:
  • Phone: 855-950-5035
  • Fax:
Mailing address:
  • Phone: 303-877-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000211-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: