Provider Demographics
NPI:1902934847
Name:STILSON, MARY LYNNE (NNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNNE
Last Name:STILSON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 N CHELTON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1306
Mailing Address - Country:US
Mailing Address - Phone:719-596-2949
Mailing Address - Fax:
Practice Address - Street 1:3205 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5101
Practice Address - Country:US
Practice Address - Phone:719-776-3443
Practice Address - Fax:719-776-3149
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94344363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care