Provider Demographics
NPI:1780829895
Name:MAURICE, ARLENE E (PA)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:E
Last Name:MAURICE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 70TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4632
Mailing Address - Country:US
Mailing Address - Phone:970-810-6353
Mailing Address - Fax:970-810-2264
Practice Address - Street 1:2001 70TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4632
Practice Address - Country:US
Practice Address - Phone:970-810-6353
Practice Address - Fax:970-810-2264
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004387207V00000X
AZ4593208800000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ598238Medicaid
AZZ144042Medicare UPIN