Healthcare Provider Details

I. General information

NPI: 1518995901
Provider Name (Legal Business Name): CHERIE MARIE MILLIRONS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LYCKMAN PL
FOUNTAIN CO
80817-2861
US

IV. Provider business mailing address

350 LYCKMAN PL
FOUNTAIN CO
80817-2861
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone: 719-632-5700
  • Fax: 719-344-7817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0002954
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: