Provider Demographics
NPI:1083603807
Name:LANDRY, NANETTE E (CNM)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:E
Last Name:LANDRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-873-5245
Mailing Address - Fax:303-873-5240
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:#225
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4514
Practice Address - Country:US
Practice Address - Phone:303-873-5245
Practice Address - Fax:303-873-5240
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO361367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07872054Medicaid
CO07872054Medicaid
COC810260Medicare PIN
CO262161YLQFMedicare PIN