Active NPI
Marleyna Augusteina Illig
- Community Health Worker
- Wheat Ridge, CO
National Provider Identifier
1598429698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 0009195
- Practice address
- 4851 Independence St
Wheat Ridge, CO 80033-6715 - Phone
- (303) 425-0300
- NPI assigned
- Oct 25, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 0009195 | AZ | Primary |
Addresses
Primary practice location
4851 Independence St
Wheat Ridge, CO 80033-6715
Mailing address
4851 Independence St
Wheat Ridge, CO 80033-6715
Phone (303) 425-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0009195 | AZ | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1598429698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4851 INDEPENDENCE ST",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800336715",
"telephone_number": "303-425-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4851 INDEPENDENCE ST",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800336715",
"telephone_number": "303-425-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLIG",
"first_name": "MARLEYNA",
"middle_name": "AUGUSTEINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-25",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "AZ",
"license": "0009195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wheat Ridge, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.