Healthcare Provider Details

I. General information

NPI: 1114978632
Provider Name (Legal Business Name): ELISE L MUSOLF MSN-FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 370
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

8540 SCARBOROUGH DR STE 370
COLORADO SPRINGS CO
80920-7519
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-2225
  • Fax: 719-358-8299
Mailing address:
  • Phone: 719-358-8270
  • Fax: 719-358-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4246
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994727-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: