Provider Demographics
NPI:1295311181
Name:WASHINGTON, MARY ABIGAIL (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ABIGAIL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17410 E 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-7224
Mailing Address - Country:US
Mailing Address - Phone:720-436-0968
Mailing Address - Fax:
Practice Address - Street 1:DEVEREUX ADVANCED BEHAVIORAL HEALTH
Practice Address - Street 2:8405 CHURCH RANCH BLVD.
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-466-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995290-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics