Healthcare Provider Details

I. General information

NPI: 1538177712
Provider Name (Legal Business Name): MARY IRENE ENZMAN HINES PHD, APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S POPLAR ST STE 202
DENVER CO
80237-1362
US

IV. Provider business mailing address

3540 S POPLAR ST STE 202
DENVER CO
80237-1362
US

V. Phone/Fax

Practice location:
  • Phone: 720-442-3615
  • Fax: 720-870-3726
Mailing address:
  • Phone: 720-442-3615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number53235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: