Healthcare Provider Details
I. General information
NPI: 1407123581
Provider Name (Legal Business Name): ELENA MIKHAILOVNA Z OLLIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/17/2011
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3207 N ACADEMY BLVD STE 3300
COLORADO SPRINGS CO
80917-5100
US
IV. Provider business mailing address
3205 N ACADEMY BLVD STE 130
COLORADO SPRINGS CO
80917-5152
US
V. Phone/Fax
- Phone: 719-632-5700
- Fax: 719-344-7870
- Phone: 719-632-5700
- Fax: 719-344-7865
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | C-APN.0001572-C-NP |
| License Number State | CO |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: