Provider Demographics
NPI:1518388586
Name:BEBAK, MARTA J (NP)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:J
Last Name:BEBAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:J
Other - Last Name:MIETUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4608 W 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2009
Mailing Address - Country:US
Mailing Address - Phone:303-379-9371
Mailing Address - Fax:
Practice Address - Street 1:4608 W 36TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2009
Practice Address - Country:US
Practice Address - Phone:303-379-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily