1285869263 NPI number — MS. INGRA R MARSKE PA-C

Table of content: MS. INGRA R MARSKE PA-C (NPI 1285869263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285869263 NPI number — MS. INGRA R MARSKE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSKE
Provider First Name:
INGRA
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARVS
Provider Other First Name:
INGRA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285869263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 PROSPECT AVE
Provider Second Line Business Mailing Address:
P. O. BOX 2715
Provider Business Mailing Address City Name:
ESTES PARK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80517-6312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-586-2200
Provider Business Mailing Address Fax Number:
970-577-4536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTES PARK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80517-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-586-2200
Provider Business Practice Location Address Fax Number:
970-577-4536
Provider Enumeration Date:
05/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA-2781 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15587762 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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