Provider Demographics
NPI:1194002071
Name:MARSH, MARY BRYN KIRSTEN (PA-C)
Entity type:Individual
Prefix:
First Name:MARY BRYN
Middle Name:KIRSTEN
Last Name:MARSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-796-8200
Mailing Address - Fax:303-796-0302
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-796-8200
Practice Address - Fax:303-796-0302
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0003242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant