Healthcare Provider Details

I. General information

NPI: 1609019009
Provider Name (Legal Business Name): DOLLY GEORGE MABEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 E 38TH AVE
DENVER CO
80207-1630
US

IV. Provider business mailing address

7155 E 38TH AVE
DENVER CO
80207-1630
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-7526
  • Fax: 303-861-0268
Mailing address:
  • Phone: 303-321-7526
  • Fax: 303-861-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP004236G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0991318-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: