Individual
MARISSA LEE FAHRBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1755 48TH ST STE 100, BOULDER, CO 80301-2712
(303) 604-5000
(720) 890-0364
Mailing address
382 S ARTHUR AVE, LOUISVILLE, CO 80027-3094
(303) 604-5000
(720) 890-0364
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
103068
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
0994226
CO
367500000X
Certified Registered Nurse Anesthetist
557356
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000171761
—
CO
Enumeration date
06/19/2015
Last updated
03/05/2020
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