Healthcare Provider Details

I. General information

NPI: 1770253254
Provider Name (Legal Business Name): MICHELLE R PARIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 WILDERNESS RD BLDG 9481
FORT CARSON CO
80913-4719
US

IV. Provider business mailing address

2751 WILDERNESS RD BLDG 9481
FORT CARSON CO
80913-4719
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-4064
  • Fax: 719-526-2998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1620253
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: