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General NPI Number Information
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NPI Number | 1699552109
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Entity Type | Individual
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Provider Name | MARISSA ERIN BACKHAUS PA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 302 3RD ST SE
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City | LOVELAND
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State | CO
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Zip | 80537-6419
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Country | US
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Telephone | 970-669-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 8450 ARISTA PL APT 316
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City | BROOMFIELD
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State | CO
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Zip | 80021-4177
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Country | US
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Telephone | 920-562-8830
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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