Individual
MARY JEAL CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
6850 E EVANS AVE STE 102, DENVER, CO 80224-2300
(303) 691-5009
Mailing address
3441 E 13TH AVE, DENVER, CO 80206-2608
(720) 941-4116
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
0995405-NP
CO
3747A0650X
Attendant Care Provider
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
N/A
CO
Enumeration date
09/12/2019
Last updated
04/16/2020
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