Healthcare Provider Details

I. General information

NPI: 1033724976
Provider Name (Legal Business Name): MARA TALIN MINASIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

IV. Provider business mailing address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

V. Phone/Fax

Practice location:
  • Phone: 720-254-1398
  • Fax: 949-703-8795
Mailing address:
  • Phone: 720-254-1398
  • Fax: 720-914-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRXN.0108437-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: