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General NPI Number Information
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NPI Number | 1437232949
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Entity Type | Individual
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Provider Name | MARY ELIZABETH STULTS P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 198 UNION BLVD SUITE 150
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City | LAKEWOOD
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State | CO
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Zip | 80228-2259
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Country | US
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Telephone | 303-892-6033
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Fax | 303-573-6929
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Provider Business Mailing Address
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Address Line | 198 UNION BLVD SUITE 150
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City | LAKEWOOD
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State | CO
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Zip | 80228-2259
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Country | US
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Telephone | 303-892-6033
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Fax | 303-573-6929
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3345
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C000333
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License Number State | MD
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