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General NPI Number Information
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NPI Number | 1013821271
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH GROUP LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 7545 US HIGHWAY 50
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City | LAMAR
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State | CO
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Zip | 81052-9565
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Country | US
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Telephone | 719-413-5261
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Fax | 719-888-1767
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Provider Business Mailing Address
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Address Line | 7545 US HIGHWAY 50
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City | LAMAR
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State | CO
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Zip | 81052-9565
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Country | US
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Telephone | 719-413-5261
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Fax | 719-888-1767
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Authorized Official
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Title or Position | PMHNP-BC OWNER
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Name | CHEYENNE ELAINE SHIPMAN
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Credential |
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Telephone | 719-252-2386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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