MEDICARE: ELEANOR ANN COLMENARES CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	0024176744	VA
2	367A00000X	Advanced Practice Midwife	0024176744	VA

General Provider Information

NPI Number	:	1780159111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR ANN COLMENARES CNM

Provider Business Mailing Address
First Line	:	1463 BROOKHAVEN DR
Second Line	:
City	:	ROCKINGHAM
State	:	VA
Zip	:	22801-3584
Country	:	US
Telephone Number	:	540-215-0082
Fax Number	:	833-972-5990

Provider Business Practice Location Address
First Line	:	10024 JACKSONS WAY
Second Line	:
City	:	PORT REPUBLIC
State	:	VA
Zip	:	24471-2337
Country	:	US
Telephone Number	:	904-304-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	12/12/2024

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