Healthcare Provider Details

I. General information

NPI: 1851564975
Provider Name (Legal Business Name): PAMELA AUBREE VANMIERLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 GARDEN OF THE GODS RD STE 120
COLORADO SPRINGS CO
80907-3416
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3200
  • Fax: 719-365-7680
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number19774
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDR.0061596
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: