MEDICARE: MS. MARCIA DRISH LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	P14489	IA

General Provider Information

NPI Number	:	1467828640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA DRISH LPN

Provider Business Mailing Address
First Line	:	4500 E CHERRY CREEK SOUTH DR
Second Line	:	SUITE 940
City	:	GLENDALE
State	:	CO
Zip	:	80246-1518
Country	:	US
Telephone Number	:	303-322-7108
Fax Number	:	303-322-9989

Provider Business Practice Location Address
First Line	:	4500 E CHERRY CREEK SOUTH DR
Second Line	:	SUITE 940
City	:	GLENDALE
State	:	CO
Zip	:	80246-1518
Country	:	US
Telephone Number	:	303-322-7108
Fax Number	:	303-322-9989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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