Healthcare Provider Details

I. General information

NPI: 1295068682
Provider Name (Legal Business Name): MELISSA J GUERRI PA-C, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

IV. Provider business mailing address

403 SUMMIT BLVD UNIT 204
BROOMFIELD CO
80021-8253
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax: 303-469-4439
Mailing address:
  • Phone: 720-401-2139
  • Fax: 303-469-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2975
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: