Provider Demographics
NPI:1952122376
Name:RAPPOPORT, MARLYSE JOY (PMHNP)
Entity type:Individual
Prefix:
First Name:MARLYSE
Middle Name:JOY
Last Name:RAPPOPORT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 WALTERS PT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8633
Mailing Address - Country:US
Mailing Address - Phone:303-877-8439
Mailing Address - Fax:
Practice Address - Street 1:2000 S BLACKHAWK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1418
Practice Address - Country:US
Practice Address - Phone:855-950-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000211-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty