Healthcare Provider Details

I. General information

NPI: 1063091668
Provider Name (Legal Business Name): ELIZABETH DUNLAP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 FORTINO BLVD STE A
PUEBLO CO
81008-2032
US

IV. Provider business mailing address

1305 FORTINO BLVD
PUEBLO CO
81008-2032
US

V. Phone/Fax

Practice location:
  • Phone: 303-600-8563
  • Fax:
Mailing address:
  • Phone: 719-545-2746
  • Fax: 719-545-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1002378-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: