Provider Demographics
NPI:1790454601
Name:PEIFFER, MARY KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:PEIFFER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:25 CROSSROADS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8419
Practice Address - Country:US
Practice Address - Phone:303-695-6106
Practice Address - Fax:303-695-1211
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2023-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0996850363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000198109Medicaid