Healthcare Provider Details

I. General information

NPI: 1255469722
Provider Name (Legal Business Name): MARY ANN PRYOR CAC1, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S SHERMAN ST
DENVER CO
80209-1621
US

IV. Provider business mailing address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

V. Phone/Fax

Practice location:
  • Phone: 303-765-2480
  • Fax: 303-765-2492
Mailing address:
  • Phone: 303-765-2480
  • Fax: 303-765-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: