Provider Demographics
NPI:1811924079
Name:GEORGE, CONSTANCE D (CNM)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:D
Other - Last Name:ZERMUEHLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:500 ELDORADO BLVD # 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST STE 320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3669
Practice Address - Country:US
Practice Address - Phone:303-318-2620
Practice Address - Fax:303-318-2629
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXM-6289367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28555082Medicaid
COC803665Medicare PIN
CO28555082Medicaid