Basic Information
| Provider Information | |||||||||
| NPI: | 1245827575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURRELL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CAROLYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2513 MCKAY LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800236582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035656563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8000 E MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037854700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2020 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APN.0996245 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 1627803 | CO | N | Nursing Service Providers | Registered Nurse |
No ID Information.