Provider Demographics
NPI:1366475147
Name:INNES, CARLEEN R (CNM)
Entity type:Individual
Prefix:
First Name:CARLEEN
Middle Name:R
Last Name:INNES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7735 WADSWORTH BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2131
Mailing Address - Country:US
Mailing Address - Phone:800-230-7526
Mailing Address - Fax:
Practice Address - Street 1:7735 WADSWORTH BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2131
Practice Address - Country:US
Practice Address - Phone:800-230-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86312367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07863129Medicaid
COCO300596Medicare PIN
CO07863129Medicaid
CO07863129Medicaid