Provider Demographics
NPI:1053385492
Name:DONNELLEY, BEVERLY ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ELAINE
Last Name:DONNELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:JESSUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1107 S LEMAY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3957
Mailing Address - Country:US
Mailing Address - Phone:970-493-7442
Mailing Address - Fax:970-493-2990
Practice Address - Street 1:1107 S LEMAY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3957
Practice Address - Country:US
Practice Address - Phone:970-493-7442
Practice Address - Fax:970-493-2990
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24489207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
84059624501OtherPACIFICARE
DO84038OtherBCBS
CO01244896Medicaid
COE46954Medicare UPIN
COC84038Medicare PIN