Provider Demographics
NPI:1003605098
Name:CARMICHAEL, JENEVIEVE DION (FNP)
Entity type:Individual
Prefix:
First Name:JENEVIEVE
Middle Name:DION
Last Name:CARMICHAEL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 MCCLELLAN RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-2282
Mailing Address - Country:US
Mailing Address - Phone:803-504-2712
Mailing Address - Fax:
Practice Address - Street 1:6813 MCCLELLAN RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2282
Practice Address - Country:US
Practice Address - Phone:803-504-2712
Practice Address - Fax:803-504-2712
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner