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General NPI Number Information
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NPI Number | 1194430173
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Entity Type | Individual
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Provider Name | MARIAH LYNN DEGUSSEME FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2023
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 9362 TEDDY LN STE 103&104
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City | LONE TREE
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State | CO
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Zip | 80124-2870
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Country | US
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Telephone | 303-955-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 3424 MEADE ST
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City | DENVER
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State | CO
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Zip | 80211-3141
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Country | US
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Telephone | 760-650-5773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0998274
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License Number State | CO
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