Provider Demographics
NPI:1497448450
Name:NDIAYE, MARIAM POLEL (NP)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:POLEL
Last Name:NDIAYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:POLEL
Other - Middle Name:
Other - Last Name:BA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9250 E COSTILLA AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3648
Mailing Address - Country:US
Mailing Address - Phone:303-644-9355
Mailing Address - Fax:
Practice Address - Street 1:12230 LIONESS WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5603
Practice Address - Country:US
Practice Address - Phone:720-644-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily