1114978632 NPI number — ELISE L MUSOLF MSN-FNP-C

Table of content: ELISE L MUSOLF MSN-FNP-C (NPI 1114978632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114978632 NPI number — ELISE L MUSOLF MSN-FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSOLF
Provider First Name:
ELISE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN-FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114978632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8540 SCARBOROUGH DR STE 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80920-7519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-358-8270
Provider Business Mailing Address Fax Number:
719-358-8299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8540 SCARBOROUGH DR STE 370
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-471-2225
Provider Business Practice Location Address Fax Number:
719-358-8299
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4246 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0994727-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)