MEDICARE: TARA LESLIE STEPHEN CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1265799787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LESLIE STEPHEN CPM

Provider Business Mailing Address
First Line	:	7120 SILVER PONDS HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4765
Country	:	US
Telephone Number	:	719-330-1851
Fax Number	:	719-494-2238

Provider Business Practice Location Address
First Line	:	7120 SILVER PONDS HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4765
Country	:	US
Telephone Number	:	719-330-1851
Fax Number	:	719-494-2238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	09/27/2013

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Directions to “ TARA LESLIE STEPHEN CPM” Practice Location

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