Basic Information
| Provider Information | |||||||||
| NPI: | 1174255962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAIZE | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | LAWRANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9659 WICKMERE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809242085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702627131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2233 ACADEMY PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809091666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193010002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.