Basic Information
| Provider Information | |||||||||
| NPI: | 1629609276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALUSHKA | ||||||||
| FirstName: | MARYNA | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15235 E 38TH AVE # 80011 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800111239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033403053 | ||||||||
| FaxNumber: | 3033403862 | ||||||||
| Practice Location | |||||||||
| Address1: | 15235 E 38TH AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800111239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033403053 | ||||||||
| FaxNumber: | 3033403862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2020 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.025537 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 511544 | 05 | OH | MEDICAID |