Provider Demographics
NPI:1174968556
Name:KUBACKI, MARY KATHERINE
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:KUBACKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 LOWELL BLVD
Mailing Address - Street 2:APT #2
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5187 LOWELL BLVD
Practice Address - Street 2:APT #2
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1000
Practice Address - Country:US
Practice Address - Phone:630-234-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program