Provider Demographics
NPI:1154655835
Name:MCNAMARA, NENETTE (NP)
Entity Type:Individual
Prefix:
First Name:NENETTE
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-0899
Mailing Address - Country:US
Mailing Address - Phone:970-563-4581
Mailing Address - Fax:970-563-0206
Practice Address - Street 1:123 WEEMINUCHE AVE
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137
Practice Address - Country:US
Practice Address - Phone:970-563-4581
Practice Address - Fax:970-563-0206
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163541163W00000X
COAPN.0010138-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84779730Medicaid