Healthcare Provider Details

I. General information

NPI: 1013065499
Provider Name (Legal Business Name): ELIZABETH ANN MENSING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OTTLEY AVE
FRUITA CO
81521-2118
US

IV. Provider business mailing address

PO BOX 130
FRUITA CO
81521-0130
US

V. Phone/Fax

Practice location:
  • Phone: 970-858-3900
  • Fax: 970-858-2743
Mailing address:
  • Phone: 970-858-2186
  • Fax: 970-858-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0038306
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: