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General NPI Number Information
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NPI Number | 1952193542
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Entity Type | Individual
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Provider Name | BENJAMIN R MIKOLAJ DNP-PMHNP
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Gender | Male
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 6160 TUTT BLVD STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-3503
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Country | US
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Telephone | 719-473-2346
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Fax | 719-465-5617
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Provider Business Mailing Address
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Address Line | 2545 PARADISE COVE VW APT 412
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6679
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Country | US
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Telephone | 719-444-8484
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Fax | 719-465-5617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0203768
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License Number State | CO
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