Provider Demographics
NPI:1043480312
Name:LIEKIS, MARY KELLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KELLY
Last Name:LIEKIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3140
Mailing Address - Country:US
Mailing Address - Phone:970-376-7188
Mailing Address - Fax:
Practice Address - Street 1:3221 NEWTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3140
Practice Address - Country:US
Practice Address - Phone:970-376-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily