Provider Demographics
NPI:1063464659
Name:MCDONOUGH, JUDITH ANNE (RN, CNS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 INVERNESS DR W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5095
Mailing Address - Country:US
Mailing Address - Phone:303-779-9676
Mailing Address - Fax:303-889-4800
Practice Address - Street 1:155 INVERNESS DR W
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5095
Practice Address - Country:US
Practice Address - Phone:303-779-9676
Practice Address - Fax:303-889-4800
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO190146163WA2000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
I3941Medicare PIN
S69919Medicare UPIN