Provider Demographics
NPI:1356440382
Name:MARCOTTE, CHRISTIE LYNN (CSFA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LYNN
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1526 HARLEQUIN DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2235
Mailing Address - Country:US
Mailing Address - Phone:303-775-1880
Mailing Address - Fax:
Practice Address - Street 1:1526 HARLEQUIN DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-2235
Practice Address - Country:US
Practice Address - Phone:303-775-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92735363AS0400X
CO04-200246ZS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0400XSpecialist/Technologist, OtherSurgical