Provider Demographics
NPI:1881267375
Name:MEHL, JANE (APN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MEHL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:IEVGENIIA
Other - Middle Name:
Other - Last Name:HAMIDULLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:5229 BLACKCLOUD LOOP
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2909
Mailing Address - Country:US
Mailing Address - Phone:719-388-6325
Mailing Address - Fax:
Practice Address - Street 1:3204 N ACADEMY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5164
Practice Address - Country:US
Practice Address - Phone:719-323-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996567-NP363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily