Provider Demographics
NPI:1538190061
Name:MCDONALD, CAROL ANN (CNM)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MCDONALD
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 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-761-1977
Mailing Address - Fax:303-761-2787
Practice Address - Street 1:3292 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1517
Practice Address - Country:US
Practice Address - Phone:303-344-3627
Practice Address - Fax:303-467-5355
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32209163W00000X
NM476367A00000X
COAPN.0170026-CNM367A00000X
CORN.0056230163W00000X
CORXN.0100024-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM04603338Medicaid
AZ775174Medicaid
P89859Medicare UPIN
TX8HBM56Medicare ID - Type UnspecifiedHSZ003
TX8HBM54Medicare ID - Type UnspecifiedHSZ001
TX8HBM57Medicare ID - Type UnspecifiedHSZ005
TX8HBM53Medicare ID - Type UnspecifiedHSZ006
TX8HBM55Medicare ID - Type UnspecifiedHSZ002