Healthcare Provider Details

I. General information

NPI: 1356037717
Provider Name (Legal Business Name): DEZERAE PAIGE ELSEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 CANYON CREST LOOP
COLORADO SPRINGS CO
80923-7410
US

IV. Provider business mailing address

1580 N LOGAN ST STE 660
DENVER CO
80203-1994
US

V. Phone/Fax

Practice location:
  • Phone: 720-244-0689
  • Fax: 720-208-4537
Mailing address:
  • Phone: 720-244-0689
  • Fax: 720-208-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0998616-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: