Healthcare Provider Details

I. General information

NPI: 1275666521
Provider Name (Legal Business Name): NANCY JO MCDONALD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 S SYCAMORE ST SUITE 302
LITTLETON CO
80120-8201
US

IV. Provider business mailing address

5500 S SYCAMORE ST SUITE 302
LITTLETON CO
80120-8201
US

V. Phone/Fax

Practice location:
  • Phone: 303-723-4285
  • Fax: 303-703-3535
Mailing address:
  • Phone: 303-723-4285
  • Fax: 303-703-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number70301
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: