Provider Demographics
NPI:1972970598
Name:PALACIOS, MARIANA (RN)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16380 E RADCLIFF PL APT A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-7134
Mailing Address - Country:US
Mailing Address - Phone:303-602-8953
Mailing Address - Fax:303-602-6804
Practice Address - Street 1:500 QUIVAS ST
Practice Address - Street 2:2ND FLOOR MC1701
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4916
Practice Address - Country:US
Practice Address - Phone:303-602-8953
Practice Address - Fax:303-602-6804
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0194938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse