Healthcare Provider Details

I. General information

NPI: 1053611301
Provider Name (Legal Business Name): MICHELLE N. QUISENBERRY FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

116 INVERNESS DR E STE 105
ENGLEWOOD CO
80112-5125
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone: 303-730-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006707
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0000561-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: