Healthcare Provider Details

I. General information

NPI: 1285122275
Provider Name (Legal Business Name): MARY ELISE NARDECCHIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 370
DENVER CO
80205-5545
US

IV. Provider business mailing address

2055 N HIGH ST STE 370
DENVER CO
80205-5545
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-6001
  • Fax: 303-839-6033
Mailing address:
  • Phone: 303-839-6001
  • Fax: 303-839-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: