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General NPI Number Information
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NPI Number | 1942331582
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Entity Type | Individual
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Provider Name | MARY RYAN SCOTT APN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 3 SUPERIOR DR STE 100B
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City | SUPERIOR
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State | CO
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Zip | 80027-8653
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Country | US
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Telephone | 303-415-8940
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Fax | 303-425-9259
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Provider Business Mailing Address
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Address Line | 2820 TABLE MESA DR
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City | BOULDER
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State | CO
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Zip | 80305-5749
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Country | US
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Telephone | 505-670-5050
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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 | R33217
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3912
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License Number State | CO
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