Healthcare Provider Details

I. General information

NPI: 1558235598
Provider Name (Legal Business Name): MICHELLE ELISE GREGORY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ELISE CRUSE PA

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 MAIN ST STE 140
WINDSOR CO
80550-5559
US

IV. Provider business mailing address

1455 MAIN ST STE 140
WINDSOR CO
80550-5559
US

V. Phone/Fax

Practice location:
  • Phone: 970-686-3950
  • Fax: 970-686-3960
Mailing address:
  • Phone: 970-686-3950
  • Fax: 970-686-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009443
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: