Provider Demographics
NPI:1124213632
Name:DONNELLY, RAILI C (PA-C)
Entity Type:Individual
Prefix:
First Name:RAILI
Middle Name:C
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 E HALE PARKWAY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:303-321-6600
Mailing Address - Fax:303-370-2668
Practice Address - Street 1:4700 E HALE PARKWAY
Practice Address - Street 2:SUITE 550
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-321-6600
Practice Address - Fax:303-321-8814
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04226224Medicaid
CO04226224Medicaid