MEDICARE: MS. MARILYN GORBACK ECKERLING ANP

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	363LC1500X	Community Health Nurse Practitioner	50345	CO

General Provider Information

NPI Number	:	1831116755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN GORBACK ECKERLING ANP

Provider Business Mailing Address
First Line	:	2962 S JOSEPHINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-6044
Country	:	US
Telephone Number	:	303-756-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2526
Country	:	US
Telephone Number	:	303-293-2220
Fax Number	:

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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