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General NPI Number Information
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NPI Number | 1528730918
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Entity Type | Individual
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Provider Name | MARIAH M SOUDER NP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1263 LAKE PLAZA DR STE 230
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3512
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Country | US
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Telephone | 719-776-3300
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Fax | 719-776-3329
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Provider Business Mailing Address
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Address Line | 6285 GAMBLER PL
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City | COLORADO SPRINGS
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State | CO
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Zip | 80908-1155
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Country | US
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Telephone | 303-829-6208
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0997121-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN.0997121-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN.0997121-NP
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License Number State | CO
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