Provider Demographics
NPI:1154384790
Name:MCCONNELL, NANCY NMI (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:NMI
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233
Mailing Address - Country:US
Mailing Address - Phone:303-452-2046
Mailing Address - Fax:303-280-0942
Practice Address - Street 1:3814 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-452-2046
Practice Address - Fax:303-280-0942
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO331363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89879848Medicaid
CO331OtherCOLORADO PA LICENSE
CO331OtherCOLORADO PA LICENSE
COS10989Medicare UPIN