Provider Demographics
NPI:1356037717
Name:ELSEN, DEZERAE PAIGE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEZERAE
Middle Name:PAIGE
Last Name:ELSEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 N LOGAN ST STE 660
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1994
Mailing Address - Country:US
Mailing Address - Phone:720-901-5822
Mailing Address - Fax:719-996-5148
Practice Address - Street 1:3720 SINTON RD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5085
Practice Address - Country:US
Practice Address - Phone:719-493-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998616-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health