Provider Demographics
NPI:1417264540
Name:HUNTER, MARY (RN, BSN, LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:RN, BSN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ALLENSPARK
Mailing Address - State:CO
Mailing Address - Zip Code:80510-0237
Mailing Address - Country:US
Mailing Address - Phone:303-747-2602
Mailing Address - Fax:303-747-0286
Practice Address - Street 1:97 2ND AVE.
Practice Address - Street 2:
Practice Address - City:ALLENSPARK
Practice Address - State:CO
Practice Address - Zip Code:80510-0237
Practice Address - Country:US
Practice Address - Phone:303-747-2602
Practice Address - Fax:303-747-0286
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist