Provider Demographics
NPI:1225280837
Name:WALSH, MARNIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9197 GRANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4329
Mailing Address - Country:US
Mailing Address - Phone:303-450-3690
Mailing Address - Fax:303-962-1511
Practice Address - Street 1:9197 GRANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4329
Practice Address - Country:US
Practice Address - Phone:303-450-3690
Practice Address - Fax:303-962-1511
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2016-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1804363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1058548OtherNCCPA