Provider Demographics
NPI:1679822530
Name:WAGGONER, MARY ELIZABETH (PMHNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC, APRN
Mailing Address - Street 1:14211 E 4TH AVE # 3-138
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8736
Mailing Address - Country:US
Mailing Address - Phone:720-262-9100
Mailing Address - Fax:720-262-9101
Practice Address - Street 1:14211 E 4TH AVE # 3-138
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8736
Practice Address - Country:US
Practice Address - Phone:720-626-0647
Practice Address - Fax:720-367-5317
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990700NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health