Healthcare Provider Details

I. General information

NPI: 1427287259
Provider Name (Legal Business Name): JOANNA MARIA PLONSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 GUNPARK DR STE 110
BOULDER CO
80301-3343
US

IV. Provider business mailing address

5450 WESTERN AVE SUITE B
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-530-3062
  • Fax: 303-530-5474
Mailing address:
  • Phone: 303-415-7599
  • Fax: 303-530-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR-51485
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: