Provider Demographics
NPI:1831844489
Name:BLAIR MICHEL, COLLEEN (PMHNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BLAIR MICHEL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 INDEPENDENCE ST STE 165
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6714
Mailing Address - Country:US
Mailing Address - Phone:303-456-0600
Mailing Address - Fax:
Practice Address - Street 1:4891 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6752
Practice Address - Country:US
Practice Address - Phone:720-316-1378
Practice Address - Fax:303-456-0601
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997347-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health