Individual
MARISSA MICHELLE AIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 COLORADO AVE, PUEBLO, CO 81004-2006
(719) 543-8711
(719) 543-0171
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-0171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0008802
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/16/2023
Last updated
09/11/2024
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