Provider Demographics
NPI:1407123581
Name:OLLIS, ELENA MIKHAILOVNA Z (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:MIKHAILOVNA Z
Last Name:OLLIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:MIKHAILOVNA
Other - Last Name:ZELTSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3205 N ACADEMY BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5152
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:719-344-7865
Practice Address - Street 1:3207 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5100
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:719-344-7840
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0001572-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health