Healthcare Provider Details

I. General information

NPI: 1518388586
Provider Name (Legal Business Name): MARTA J BEBAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTA J MIETUS

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 W 36TH AVE
DENVER CO
80212-2009
US

IV. Provider business mailing address

4608 W 36TH AVE
DENVER CO
80212-2009
US

V. Phone/Fax

Practice location:
  • Phone: 303-379-9371
  • Fax:
Mailing address:
  • Phone: 303-379-9371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0990709
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: