Healthcare Provider Details

I. General information

NPI: 1942331582
Provider Name (Legal Business Name): MARY RYAN SCOTT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUPERIOR DR STE 100B
SUPERIOR CO
80027-8653
US

IV. Provider business mailing address

2820 TABLE MESA DR
BOULDER CO
80305-5749
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-8940
  • Fax: 303-425-9259
Mailing address:
  • Phone: 505-670-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33217
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3912
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: