Provider Demographics
NPI:1194208736
Name:MCNULTY, DEANNA L (DNP)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:L
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-0189
Mailing Address - Country:US
Mailing Address - Phone:719-839-1923
Mailing Address - Fax:833-539-1731
Practice Address - Street 1:18100 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9404
Practice Address - Country:US
Practice Address - Phone:719-839-1923
Practice Address - Fax:844-681-3288
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994084-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily