=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780159111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELEANOR ANN COLMENARES CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10024 JACKSONS WAY
-----------------------------------------------------
City | PORT REPUBLIC
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24471-2337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-304-5405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1463 BROOKHAVEN DR
-----------------------------------------------------
City | ROCKINGHAM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-3584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-215-0082
-----------------------------------------------------
Fax | 833-972-5990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | 0024176744
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 0024176744
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------