Provider Demographics
NPI:1275153413
Name:PIZZIMENTI, MELISSA M
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:PIZZIMENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5387 MANHATTAN CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4283
Mailing Address - Country:US
Mailing Address - Phone:303-494-7773
Mailing Address - Fax:303-494-1104
Practice Address - Street 1:5387 MANHATTAN CIR STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4283
Practice Address - Country:US
Practice Address - Phone:303-494-7773
Practice Address - Fax:303-494-1104
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0006792363A00000X
IL085-008025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant