Provider Demographics
NPI:1891015822
Name:HUESKE, MARY KATHLEEN IRENE (RN, MSN, CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN IRENE
Last Name:HUESKE
Suffix:
Gender:F
Credentials:RN, MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:6089 S BEMIS ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2505
Mailing Address - Country:US
Mailing Address - Phone:303-885-5432
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST # MC3240
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-602-2718
Practice Address - Fax:303-602-2719
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO411611163W00000X
8537367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO388056YQPGMedicare PIN
CO388056YQN9Medicare PIN