Provider Demographics
NPI:1346223898
Name:ENGELLENNER, NANCY K (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:ENGELLENNER
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 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-441-0587
Mailing Address - Fax:303-996-0801
Practice Address - Street 1:4745 ARAPAHOE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:303-441-0587
Practice Address - Fax:303-996-0801
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COENG104260252363LW0102X
COAPN.0001133-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45102368Medicaid
COP21366Medicare UPIN
COC800062Medicare PIN
CO45102368Medicaid
CO45102368Medicaid