Provider Demographics
NPI:1699128405
Name:MAIERS, MARISA MICHELLE
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:MICHELLE
Last Name:MAIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 W 35TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1758
Mailing Address - Country:US
Mailing Address - Phone:303-641-9673
Mailing Address - Fax:
Practice Address - Street 1:1405 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2211
Practice Address - Country:US
Practice Address - Phone:303-504-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program