Individual
MARIAH M SOUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1263 LAKE PLAZA DR STE 230, COLORADO SPRINGS, CO 80906-3512
(719) 776-3300
(719) 776-3329
Mailing address
6285 GAMBLER PL, COLORADO SPRINGS, CO 80908-1155
(303) 829-6208
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APN.0997121-NP
CO
363LA2200X
Adult Health Nurse Practitioner
APN.0997121-NP
CO
363LP2300X
Primary Care Nurse Practitioner
Primary
APN.0997121-NP
CO
Other
Enumeration date
10/04/2021
Last updated
08/22/2023
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