Provider Demographics
NPI:1124884291
Name:TREJO, MICHELLE LYNN (MPA, BSN, BSP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:TREJO
Suffix:
Gender:F
Credentials:MPA, BSN, BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 DEPEW ST
Mailing Address - Street 2:#690
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214
Mailing Address - Country:US
Mailing Address - Phone:720-215-0552
Mailing Address - Fax:
Practice Address - Street 1:1990 DEPEW ST
Practice Address - Street 2:#690
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214
Practice Address - Country:US
Practice Address - Phone:720-215-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO920398696172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver