Provider Demographics
NPI:1518900299
Name:MALISZEWSKI, MAUREEN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MALISZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:DURANGO NEPHROLOGY ASSOCIATES
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-259-4713
Mailing Address - Fax:970-259-2466
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:DURANGO NEPHROLOGY ASSOCIATES
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-259-4713
Practice Address - Fax:970-259-2466
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90404505Medicaid
COS22710Medicare UPIN
COC808074Medicare PIN