Doctor Name: | MAUREEN PETIK |
NPI Number: | 1447619002 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MT.0014981 |
Business Practice Address: | 405 Windchime Pl Colorado Springs, CO - 809191984 |
Business Phone Number: | 7195330077 |
Business Fax Number: | |
Mailing Address: | 5415 Paradox Dr, COLORADO SPRINGS |
State: | CO |
Postal Code: | 809237632 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/11/2016 |
NPI Last Update Date: | 02/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MT.0014981 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |