Basic Information
| Provider Information | |||||||||
| NPI: | 1538190061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037611977 | ||||||||
| FaxNumber: | 3037612787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3292 PEORIA ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800101517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033443627 | ||||||||
| FaxNumber: | 3034675355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R32209 | NM | N | Nursing Service Providers | Registered Nurse | 367A00000X | 476 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | APN.0170026-CNM | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 163W00000X | RN.0056230 | CO | N | Nursing Service Providers | Registered Nurse | 367A00000X | RXN.0100024-CNM | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 04603338 | 05 | NM | MEDICAID | 775174 | 05 | AZ | MEDICAID |