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NPI Code Detail

MEDICARE: MRS. DONNA RUTH ELLSWORTH MSN, NP

MEDICARE:  MRS. DONNA RUTH ELLSWORTH  MSN, NP
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
1363LG0600XGerontology Nurse Practitioner17590CO

General Provider Information

NPI Number : 1790705549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA RUTH ELLSWORTH MSN, NP
Provider Business Mailing Address
First Line : 11700 W 2ND PL
Second Line : STE 450
City : LAKEWOOD
State : CO
Zip : 80228-1719
Country : US
Telephone Number : 607-349-8450
Fax Number :
Provider Business Practice Location Address
First Line : 8405 W ALAMEDA AVE
Second Line :
City : LAKEWOOD
State : CO
Zip : 80226-2908
Country : US
Telephone Number : 720-974-5400
Fax Number : 720-974-4990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 06/28/2016

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