Provider Demographics
NPI:1629609276
Name:HALUSHKA, MARYNA (CNP)
Entity type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:HALUSHKA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15235 E 38TH AVE # 80011
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1239
Mailing Address - Country:US
Mailing Address - Phone:303-340-3053
Mailing Address - Fax:303-340-3862
Practice Address - Street 1:15235 E 38TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1239
Practice Address - Country:US
Practice Address - Phone:303-340-3053
Practice Address - Fax:303-340-3862
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH511544Medicaid