Healthcare Provider Details

I. General information

NPI: 1437879392
Provider Name (Legal Business Name): ELI S MAUKSCH DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 MAIN AVE
DURANGO CO
81301-5919
US

IV. Provider business mailing address

2577 MAIN AVE
DURANGO CO
81301-5919
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-8382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN60991461
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70960
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000530-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: