Provider Demographics
NPI:1871965160
Name:HEALEY, MARY SUZANNE (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:HEALEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 SE CHERRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-8123
Mailing Address - Country:US
Mailing Address - Phone:303-883-4604
Mailing Address - Fax:
Practice Address - Street 1:10465 PARK MEADOWS DR STE 104
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5320
Practice Address - Country:US
Practice Address - Phone:303-799-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCNM2875367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife