Provider Demographics
NPI:1831316256
Name:LANDERS, MARIANNE N
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:N
Last Name:LANDERS
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 1:775 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-8304
Mailing Address - Country:US
Mailing Address - Phone:303-663-2205
Mailing Address - Fax:
Practice Address - Street 1:10065 E HARVARD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5968
Practice Address - Country:US
Practice Address - Phone:303-850-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104410208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
008501OtherKAISER-COMMERCIAL NUMBER