Provider Demographics
NPI:1134190754
Name:BARGHELAME, MARY (NP-C)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BARGHELAME
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 MAIN ST
Mailing Address - Street 2:SUIT 100
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5559
Mailing Address - Country:US
Mailing Address - Phone:970-686-3950
Mailing Address - Fax:970-686-3960
Practice Address - Street 1:1455 MAIN ST
Practice Address - Street 2:SUIT 100
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5559
Practice Address - Country:US
Practice Address - Phone:970-686-3950
Practice Address - Fax:970-686-3960
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-88446163W00000X
CONP-1596363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46622837Medicaid
COP00944852OtherMEDICARE RAILROAD CARRIER PTAN
COC21168Medicare PIN
COS63918Medicare UPIN
COP00944852OtherMEDICARE RAILROAD CARRIER PTAN