Provider Demographics
NPI:1528730918
Name:SOUDER, MARIAH M (NP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:M
Last Name:SOUDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6285 GAMBLER PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1155
Mailing Address - Country:US
Mailing Address - Phone:303-829-6208
Mailing Address - Fax:
Practice Address - Street 1:1263 LAKE PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3512
Practice Address - Country:US
Practice Address - Phone:719-776-3300
Practice Address - Fax:719-776-3329
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997121-NP363L00000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health