Healthcare Provider Details

I. General information

NPI: 1518924455
Provider Name (Legal Business Name): MAUREEN PRESTON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 S CLARKSON ST
ENGLEWOOD CO
80113-2811
US

IV. Provider business mailing address

3425 S CLARKSON ST
ENGLEWOOD CO
80113-2811
US

V. Phone/Fax

Practice location:
  • Phone: 303-789-8000
  • Fax: 303-789-8441
Mailing address:
  • Phone: 303-789-8000
  • Fax: 303-789-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number63623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: