Provider Demographics
NPI:1760678288
Name:MCCALLUM-MANZANARES, COLLEEN ANN (FNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:MCCALLUM-MANZANARES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:MCCALLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2525 S DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5817
Mailing Address - Country:US
Mailing Address - Phone:303-765-6969
Mailing Address - Fax:303-778-5661
Practice Address - Street 1:2525 S DOWNING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5817
Practice Address - Country:US
Practice Address - Phone:303-765-6969
Practice Address - Fax:303-778-5661
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004643-NP363L00000X, 363LP0808X
COAPN0004643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33189013Medicaid
CO33189013Medicaid
CO33189013Medicaid
COCOA102239Medicare PIN