Provider Demographics
NPI:1790705549
Name:ELLSWORTH, DONNA RUTH (MSN, NP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RUTH
Last Name:ELLSWORTH
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Gender:F
Credentials:MSN, NP
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Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:STE 450
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1719
Mailing Address - Country:US
Mailing Address - Phone:607-349-8450
Mailing Address - Fax:
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2908
Practice Address - Country:US
Practice Address - Phone:720-974-5400
Practice Address - Fax:720-974-4990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-06-28
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Provider Licenses
StateLicense IDTaxonomies
CO17590363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS30033Medicare UPIN