Provider Demographics
NPI:1225354608
Name:SOUCY, MAUREEN (LPN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SOUCY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 PORTLAND PL
Mailing Address - Street 2:#6
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3371
Mailing Address - Country:US
Mailing Address - Phone:908-494-6334
Mailing Address - Fax:
Practice Address - Street 1:1031 PORTLAND PL
Practice Address - Street 2:#6
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3371
Practice Address - Country:US
Practice Address - Phone:908-494-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47407164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse