Provider Demographics
NPI:1891023131
Name:MACKINNON, MELISSA EBNER (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:EBNER
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 E HAMPDEN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4844
Mailing Address - Country:US
Mailing Address - Phone:303-807-8192
Mailing Address - Fax:
Practice Address - Street 1:7535 E HAMPDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4844
Practice Address - Country:US
Practice Address - Phone:303-807-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP10132363LF0000X
CO10132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50002759Medicaid