Provider Demographics
NPI:1871322180
Name:DISESA, ELLEN JANE (WHNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:DISESA
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 N CLAY ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5192
Mailing Address - Country:US
Mailing Address - Phone:720-746-8533
Mailing Address - Fax:
Practice Address - Street 1:9780 PYRAMID CT STE 260
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-7060
Practice Address - Country:US
Practice Address - Phone:720-420-1570
Practice Address - Fax:866-657-9471
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000000-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health