Provider Demographics
NPI:1508009143
Name:MASCIOTRA, MARIE LOUISE (RN,MSN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:MASCIOTRA
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2531
Mailing Address - Country:US
Mailing Address - Phone:719-542-4233
Mailing Address - Fax:
Practice Address - Street 1:929 ELM ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2531
Practice Address - Country:US
Practice Address - Phone:719-542-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48613163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse