Individual
MAEGAN I DIVECHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
215 S PARKSIDE DR STE 215, COLORADO SPRINGS, CO 80910-3131
(303) 338-4545
Mailing address
10350 E DAKOTA AVE STE 125, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA. 0003523
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23376
KAISER COMMERCIAL NUMBER
CO
05
—
55259227
—
CO
Enumeration date
08/27/2012
Last updated
06/19/2021
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