Provider Demographics
NPI:1598753766
Name:THOMSIC, MARY CATHERINE ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:MARY CATHERINE
Middle Name:ELIZABETH
Last Name:THOMSIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:303-436-3327
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-436-3327
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004930-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22120521Medicaid
MT1407089OtherDEA
CO22120521Medicaid
Q46437Medicare UPIN