Provider Demographics
NPI:1063841104
Name:GASIENICA, MARGARET I (PAC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:I
Last Name:GASIENICA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 E HAMPDEN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2792
Mailing Address - Country:US
Mailing Address - Phone:303-783-8844
Mailing Address - Fax:303-783-2002
Practice Address - Street 1:499 E HAMPDEN AVE STE 220
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2792
Practice Address - Country:US
Practice Address - Phone:303-783-8844
Practice Address - Fax:303-783-2002
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0003829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA0003829OtherCOLORADO LICENSE