NPI 1700584034 · live from the CMS NPI Registry
Marissa Michelle Aide, PA
Physician Assistant in Pueblo, CO. National Provider Identifier 1700584034, active.
NPI record
| NPI | 1700584034 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 300 Colorado Ave, Pueblo, CO 81004 |
| Practice phone | 719-543-8711 |
| Mailing address | 110 E Routt Ave, Pueblo, CO 81004 |
| Enumerated | February 16, 2023 |
| Last updated | September 11, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Physician Assistant primary | 363A00000X | PA.0008802 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.