Provider Demographics
NPI:1275700833
Name:PETKOVICH, NOREEN ELIZABETH (NCMT)
Entity Type:Individual
Prefix:MRS
First Name:NOREEN
Middle Name:ELIZABETH
Last Name:PETKOVICH
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5268
Mailing Address - Country:US
Mailing Address - Phone:720-280-2624
Mailing Address - Fax:
Practice Address - Street 1:3510 W MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-5268
Practice Address - Country:US
Practice Address - Phone:720-280-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO524519-06174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist