Provider Demographics
NPI:1609897230
Name:SATTERTHWAITE, MARY SUSAN (APRN-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:SATTERTHWAITE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:AUERBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-482-3712
Mailing Address - Fax:970-266-4190
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-482-3712
Practice Address - Fax:970-266-4190
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO117922363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10024280Medicaid
COP64476Medicare UPIN
CO3265375Medicaid