Healthcare Provider Details

I. General information

NPI: 1124549241
Provider Name (Legal Business Name): MEGAN MOSIER DECENZO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 220
COLORADO SPRINGS CO
80910-3147
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-634-1532
  • Fax: 719-634-1715
Mailing address:
  • Phone: 970-624-2410
  • Fax: 970-492-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005021
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: