Healthcare Provider Details

I. General information

NPI: 1427003664
Provider Name (Legal Business Name): MARY S NOLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 E STAPLETON DR N SUITE #A-130
DENVER CO
80216-3318
US

IV. Provider business mailing address

5855 E STAPLETON DR N SUITE #A-130
DENVER CO
80216-3318
US

V. Phone/Fax

Practice location:
  • Phone: 303-371-7444
  • Fax: 303-371-7364
Mailing address:
  • Phone: 303-371-7444
  • Fax: 303-371-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27508
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: