MRS. MARILYN ANN GANDOLPH


Address: 325 W S Boulder Rd Ste 101, Louisville, CO 80027-1130
Phone: 7205191596

MRS. MARILYN ANN GANDOLPH (NPI# 1154388148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154388148
Entity Type Individual
Full Name MRS. MARILYN ANN GANDOLPH
Credential PHYSICIAN ASSISTANT
Practice Address 325 W S Boulder Rd Ste 101
Louisville
CO 80027-1130
Practice Telephone 7205191596
Practice Fax Number 7205429408
Mailing Telephone 7205191596
Mailing Fax Number 7205429408
Enumeration Date 2006-04-26
Last Update Date 2018-03-17
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
3015 CO Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
400 East Simpson St., Suite 101, Lafayette, CO 80026 7205191596 7205429408

Office Location

Street Address 325 W S BOULDER RD STE 101
City LOUISVILLE
State CO
Zip Code 80027-1130

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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

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1629582739 Addie C Rosenberger Physician Assistant 200 E Chestnut St Bldg Ste 303, Louisville, KY 40202-1831 2017-11-28
1750749362 Erin Mary Quinn Physician Assistant 90 Health Park Dr Ste 340, Louisville, CO 80027-9586 2016-02-10
1043465164 Myron Jeffrey Hardesty Physician Assistant 7505 New Lagrange Road, Louisville, KY 40222 2008-11-18
1992966279 Sharin Lynn Berger Physician Assistant 928 Treece St, Louisville, CO 80027-8511 2008-06-19
1528112166 Wendy M Warren Physician Assistant 3999 Dutchmans Ln Ste 6f, Louisville, KY 40207-4724 2007-01-22
1942245253 Connie Ann Melton Physician Assistant 1025 S 2nd St, Louisville, KY 40203-2823 2006-06-19
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Competitor

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City LOUISVILLE
Zip Code 80027

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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