MEDICARE: MARY BRIQUELLE HOPPES RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	1692739	CO

General Provider Information

NPI Number	:	1649031048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BRIQUELLE HOPPES RN

Provider Business Mailing Address
First Line	:	11383 GRAY ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80020-6824
Country	:	US
Telephone Number	:	502-593-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W 122ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3435
Country	:	US
Telephone Number	:	720-296-5557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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