Healthcare Provider Details

I. General information

NPI: 1053260091
Provider Name (Legal Business Name): ELYSSA PALLAI NBCWHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4951
EAGLE CO
81631-4951
US

IV. Provider business mailing address

PO BOX 4951
EAGLE CO
81631-4951
US

V. Phone/Fax

Practice location:
  • Phone: 970-306-5546
  • Fax:
Mailing address:
  • Phone: 970-306-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4202404
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: