Provider Demographics
NPI:1548869860
Name:NEWVINE, COLLEEN R (FNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:R
Last Name:NEWVINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 W 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5263
Mailing Address - Country:US
Mailing Address - Phone:303-503-0041
Mailing Address - Fax:
Practice Address - Street 1:2831 W 133RD AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5263
Practice Address - Country:US
Practice Address - Phone:303-350-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995880-NP.363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05-186-0119OtherDRIVER LICENSE