Healthcare Provider Details

I. General information

NPI: 1730853581
Provider Name (Legal Business Name): MS. MARIAH WINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

IV. Provider business mailing address

1939 SPRUCE CT
ERIE CO
80516-7977
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax:
Mailing address:
  • Phone: 720-378-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007044
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: