Healthcare Provider Details

I. General information

NPI: 1720081227
Provider Name (Legal Business Name): ERIN L MELLOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST ST.
LIMON CO
80828-1120
US

IV. Provider business mailing address

820 1ST ST.
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-2367
  • Fax: 719-775-2365
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2037
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: