Provider Demographics
NPI:1093839730
Name:MARINELLO, LAURA S (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:MARINELLO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:51 WEST 84TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4882
Mailing Address - Country:US
Mailing Address - Phone:303-427-1601
Mailing Address - Fax:303-426-6412
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-392-0900
Practice Address - Fax:970-506-3796
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMM1400554OtherDEA
COCO301171Medicare PIN