Healthcare Provider Details

I. General information

NPI: 1891015822
Provider Name (Legal Business Name): MARY KATHLEEN IRENE HUESKE RN, MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST # MC3240
DENVER CO
80204-4507
US

IV. Provider business mailing address

6089 S BEMIS ST
LITTLETON CO
80120-2505
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2718
  • Fax: 303-602-2719
Mailing address:
  • Phone: 303-885-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number411611
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8537
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: