Provider Demographics
NPI:1790809796
Name:SERKOWSKI, MARY MARGARET (MA DABNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:SERKOWSKI
Suffix:
Gender:F
Credentials:MA DABNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4627
Mailing Address - Country:US
Mailing Address - Phone:303-904-1624
Mailing Address - Fax:303-904-0075
Practice Address - Street 1:14140 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-9564
Practice Address - Country:US
Practice Address - Phone:303-425-3213
Practice Address - Fax:303-466-9772
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist