Provider Demographics
NPI:1609148543
Name:MCINTIRE, MARCELLA STEPHANIE
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:STEPHANIE
Last Name:MCINTIRE
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 1:7223 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9517
Mailing Address - Country:US
Mailing Address - Phone:303-673-9246
Mailing Address - Fax:
Practice Address - Street 1:899 HIGHWAY 287
Practice Address - Street 2:SIUTE 300
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7005
Practice Address - Country:US
Practice Address - Phone:303-466-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator