=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356037717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEZERAE PAIGE ELSEN PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2023
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1580 N LOGAN ST STE 660
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-901-5822
-----------------------------------------------------
Fax | 719-996-5148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1580 N LOGAN ST STE 660
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-901-5822
-----------------------------------------------------
Fax | 719-996-5148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APN.0998616-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------