Basic Information
| Provider Information | |||||||||
| NPI: | 1013252758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESCHER ALLEN | ||||||||
| FirstName: | SALLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 CHAMBERS RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800117117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 791 CHAMBERS RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800117112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
| FaxNumber: | 3036172365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 58663 | CO | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | RN.0058663 | CO | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363L00000X | APN.0990710-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | APN.0990710-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | RXN.0101194-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 31480021 | 05 | CO | MEDICAID | MM3455688 | 01 | CO | DEA | OTHER |