Provider Demographics
NPI:1669488318
Name:MENA, EVELYN HOPE (CNS, RXN)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:HOPE
Last Name:MENA
Suffix:
Gender:F
Credentials:CNS, RXN
Other - Prefix:MS
Other - First Name:HOPE
Other - Middle Name:
Other - Last Name:MENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS, RXN
Mailing Address - Street 1:2860 S CIRCLE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4113
Mailing Address - Country:US
Mailing Address - Phone:719-473-2346
Mailing Address - Fax:719-577-9627
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4113
Practice Address - Country:US
Practice Address - Phone:719-473-2346
Practice Address - Fax:719-577-9627
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73993364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46004Medicare UPIN
COC805050Medicare PIN