Provider Demographics
NPI:1124549241
Name:DECENZO, MEGAN MOSIER (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MOSIER
Last Name:DECENZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2410
Mailing Address - Fax:970-492-4173
Practice Address - Street 1:175 S UNION BLVD STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3147
Practice Address - Country:US
Practice Address - Phone:719-634-1532
Practice Address - Fax:719-634-1715
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2024-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0005021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant