Healthcare Provider Details

I. General information

NPI: 1811970379
Provider Name (Legal Business Name): MARY B TRELOAR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 300
BOULDER CO
80303-1080
US

IV. Provider business mailing address

345 MAXWELL AVE
BOULDER CO
80304-3972
US

V. Phone/Fax

Practice location:
  • Phone: 720-854-7400
  • Fax: 720-854-7007
Mailing address:
  • Phone: 303-544-5777
  • Fax: 303-544-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number76129
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: