Individual
MADELINE ANN BASSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
400 W 16TH ST, SCEMA, PUEBLO, CO 81003-2745
(719) 584-4306
Mailing address
PO BOX 1881, PUEBLO, CO 81002-1881
(719) 584-4306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004873
CO
Other
Enumeration date
12/09/2016
Last updated
12/21/2016
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