Provider Demographics
NPI:1538869771
Name:PACHECO, MARISSA LYNN JEAN
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN JEAN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:CO
Mailing Address - Zip Code:80654-7900
Mailing Address - Country:US
Mailing Address - Phone:720-512-1914
Mailing Address - Fax:
Practice Address - Street 1:2853 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5040
Practice Address - Country:US
Practice Address - Phone:970-256-9424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program