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General NPI Number Information
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NPI Number | 1295149391
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Entity Type | Individual
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Provider Name | MARISSA MCNELLY LE DPM
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Gender | Female
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 3835 HARLAN ST
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-5111
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Country | US
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Telephone | 877-674-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 1784 LEYDEN ST
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City | DENVER
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State | CO
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Zip | 80220-1624
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Country | US
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Telephone | 920-277-8957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 41000316A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD.0000970
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1099-25
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License Number State | WI
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