Provider Demographics
NPI:1679633531
Name:NELLIGAN, DONNA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E ORCHARD RD
Mailing Address - Street 2:102NE
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80121-8000
Mailing Address - Country:US
Mailing Address - Phone:303-730-1313
Mailing Address - Fax:303-730-2090
Practice Address - Street 1:191 E ORCHARD RD
Practice Address - Street 2:102NE
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80121-8000
Practice Address - Country:US
Practice Address - Phone:303-730-1313
Practice Address - Fax:303-730-2090
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07002684Medicaid