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General NPI Number Information
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NPI Number | 1841067832
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Entity Type | Individual
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Provider Name | MARISA RENEE LLAMAS
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Gender | Female
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2740 SOUTH AVE W STE 101
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City | MISSOULA
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State | MT
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Zip | 59804-5137
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Country | US
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Telephone | 406-728-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 60386 E LOOSE REINS PL
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City | TUCSON
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State | AZ
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Zip | 85739-5903
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Country | US
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Telephone |
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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 | MED-PAC-LIC-144583-
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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