Healthcare Provider Details

I. General information

NPI: 1104747765
Provider Name (Legal Business Name): ELISSA PALMQUIST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S PUBLIC RD
LAFAYETTE CO
80026-2143
US

IV. Provider business mailing address

1125 RED IRON CT
ERIE CO
80516-7308
US

V. Phone/Fax

Practice location:
  • Phone: 720-431-7007
  • Fax:
Mailing address:
  • Phone: 720-431-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0196928
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: