Healthcare Provider Details

I. General information

NPI: 1063748176
Provider Name (Legal Business Name): MICHELLE DESHAIES MS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4229
US

IV. Provider business mailing address

2014 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4229
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-6614
  • Fax: 970-947-0155
Mailing address:
  • Phone: 970-945-6614
  • Fax: 970-947-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number57481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: