Healthcare Provider Details

I. General information

NPI: 1053953786
Provider Name (Legal Business Name): EILEEN DEITSCH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3735
US

IV. Provider business mailing address

18944 PEBBLE BEACH WAY
MONUMENT CO
80132-8932
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-4444
  • Fax: 719-255-4446
Mailing address:
  • Phone: 973-479-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0995020-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: