Provider Demographics
NPI:1679047708
Name:ADLESICH, MARISA (PA-C)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:ADLESICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:BERTOLONE-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4758
Mailing Address - Country:US
Mailing Address - Phone:303-930-7803
Mailing Address - Fax:303-930-5503
Practice Address - Street 1:8820 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6805
Practice Address - Country:US
Practice Address - Phone:303-386-7622
Practice Address - Fax:303-427-6800
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA203098363A00000X
NE2314363A00000X
COPA.0006105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty