Provider Demographics
NPI:1285869263
Name:MARSKE, INGRA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:INGRA
Middle Name:R
Last Name:MARSKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:INGRA
Other - Middle Name:R
Other - Last Name:MARVS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:555 PROSPECT AVE
Mailing Address - Street 2:P. O. BOX 2715
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-586-2200
Mailing Address - Fax:970-577-4536
Practice Address - Street 1:555 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6312
Practice Address - Country:US
Practice Address - Phone:970-586-2200
Practice Address - Fax:970-577-4536
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-2781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15587762Medicaid
CO15587762Medicaid