Provider Demographics
NPI:1942387493
Name:STUART, MARY SUE (APN,RXN, CNS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUE
Last Name:STUART
Suffix:
Gender:F
Credentials:APN,RXN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 INVERNESS DRIVE WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5095
Mailing Address - Country:US
Mailing Address - Phone:303-730-8858
Mailing Address - Fax:
Practice Address - Street 1:5500 S SYCAMORE ST.
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8201
Practice Address - Country:US
Practice Address - Phone:303-730-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0000330-CNS363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0000330-CNSOtherAPN LICENSE
CORXN.0097170-CNSOtherRXN
CORN.0045866OtherRN LICENSE
CORXN.0097170-CNSOtherRXN