Provider Demographics
NPI:1962487900
Name:LEAHY, MARIANNE B (PA-C)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:B
Last Name:LEAHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:719-365-1950
Mailing Address - Fax:719-364-0022
Practice Address - Street 1:5818 N NEVADA AVE STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3505
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-364-0022
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000960363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53379594Medicaid
S95919Medicare UPIN
CO53379594Medicaid