Healthcare Provider Details

I. General information

NPI: 1144301649
Provider Name (Legal Business Name): MARY ELIZABETH ELLIOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY
DENVER CO
80203-2706
US

IV. Provider business mailing address

674 CLERMONT ST
DENVER CO
80220-5024
US

V. Phone/Fax

Practice location:
  • Phone: 303-813-7735
  • Fax:
Mailing address:
  • Phone: 303-722-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number125037
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: