Provider Demographics
NPI:1053953786
Name:DEITSCH, EILEEN (PMHNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DEITSCH
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 1:18944 PEBBLE BEACH WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8932
Mailing Address - Country:US
Mailing Address - Phone:973-479-0171
Mailing Address - Fax:
Practice Address - Street 1:1420 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3735
Practice Address - Country:US
Practice Address - Phone:719-255-4444
Practice Address - Fax:719-255-4446
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995020-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health