Provider Demographics
NPI:1770648156
Name:MCMENAMIN, CONSTANCE A (APN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:MCMENAMIN
Suffix:
Gender:F
Credentials:APN
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 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000725363LF0000X
CO0990507363LF0000X
COAPN.0990507-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0990507OtherCO STATE BOARD OF NURSING/ APN
CO0080018OtherCO STATE BOARD OF NURSING/ RN
CO0100506OtherCO STATE BOARD OF NURSING/RXN
CO0100506OtherCO STATE BOARD OF NURSING/RXN
CO0100506OtherCO STATE BOARD OF NURSING/RXN