Provider Demographics
NPI:1962664649
Name:MACDONALD, MAREN KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:KAY
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W COLORADO AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3882
Mailing Address - Country:US
Mailing Address - Phone:719-473-2368
Mailing Address - Fax:
Practice Address - Street 1:2020 W COLORADO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3882
Practice Address - Country:US
Practice Address - Phone:719-473-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine