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General NPI Number Information
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NPI Number | 1851879662
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Entity Type | Individual
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Provider Name | MARISSA STARR FNP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 1000 RUSH DR
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City | SALIDA
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State | CO
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Zip | 81201-9627
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Country | US
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Telephone | 719-530-2416
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4535
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City | BUENA VISTA
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State | CO
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Zip | 81211-4535
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Country | US
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Telephone | 720-353-0219
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0993963-NP
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License Number State | CO
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