Individual
MICHELLE L FUSSNECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6450 W 120TH AVE UNIT A, BROOMFIELD, CO 80020
(720) 274-9200
Mailing address
1621 S WOLCOTT CT, DENVER, CO 80219-4334
(720) 530-6404
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0004945
CO
363AM0700X
Medical Physician Assistant
PA2016-0060
NM
Other
Enumeration date
08/09/2016
Last updated
06/21/2018
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