Provider Demographics
NPI:1508310558
Name:PINO, MARLENE ALICE (APRN)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ALICE
Last Name:PINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:ALICE
Other - Last Name:IMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7114 W JEFFERSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2356
Mailing Address - Country:US
Mailing Address - Phone:720-710-7332
Mailing Address - Fax:720-306-5332
Practice Address - Street 1:7114 W JEFFERSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2356
Practice Address - Country:US
Practice Address - Phone:720-710-7332
Practice Address - Fax:720-306-5332
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993043-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health