Provider Demographics
NPI:1992115596
Name:DAIGLER-KLUGE, MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DAIGLER-KLUGE
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 1:4384 S FEDERAL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5311
Mailing Address - Country:US
Mailing Address - Phone:720-853-4230
Mailing Address - Fax:585-723-6705
Practice Address - Street 1:4384 S FEDERAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-5311
Practice Address - Country:US
Practice Address - Phone:720-853-4230
Practice Address - Fax:585-723-6705
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999350363LF0000X
NY338505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90000225978Medicaid
NYJ400143158/70008AGRPMedicare PIN
NY03860400Medicaid