Provider Demographics
NPI:1679063119
Name:MAURONER, LILLIAN GRACE (DO)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:GRACE
Last Name:MAURONER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N HIGH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5545
Mailing Address - Country:US
Mailing Address - Phone:303-301-9010
Mailing Address - Fax:303-830-3165
Practice Address - Street 1:2055 N HIGH ST STE 270
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5545
Practice Address - Country:US
Practice Address - Phone:303-301-9010
Practice Address - Fax:303-830-3165
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00739512080P0210X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program