Provider Demographics
NPI:1952733198
Name:PAGE, MELISSA J (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:PAGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 E MISSISSIPPI AVE
Mailing Address - Street 2:100B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3561
Mailing Address - Country:US
Mailing Address - Phone:303-695-1338
Mailing Address - Fax:
Practice Address - Street 1:13650 E MISSISSIPPI AVE
Practice Address - Street 2:100B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3561
Practice Address - Country:US
Practice Address - Phone:303-695-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0101175-NP363L00000X
CO0991130363LF0000X
COAPN.0991130-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000148036Medicaid