Provider Demographics
NPI:1417405432
Name:VOSS, MARYJO ANNE (RN)
Entity Type:Individual
Prefix:
First Name:MARYJO
Middle Name:ANNE
Last Name:VOSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARYJO
Other - Middle Name:ANNE
Other - Last Name:ROATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9540 S FLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-8529
Mailing Address - Country:US
Mailing Address - Phone:308-360-2323
Mailing Address - Fax:
Practice Address - Street 1:2500 S HAVANA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1618
Practice Address - Country:US
Practice Address - Phone:303-338-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0075750163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse