Provider Demographics
NPI:1407813447
Name:ARNOLD, MARY NORINE (PA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:NORINE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:32214 ELLINGWOOD TRL STE 210
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9719
Practice Address - Country:US
Practice Address - Phone:303-679-2020
Practice Address - Fax:303-670-2160
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000578363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ08302Medicare UPIN
CO524168Medicare ID - Type Unspecified