Healthcare Provider Details

I. General information

NPI: 1184274011
Provider Name (Legal Business Name): CHANTAL DENGAH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 PEORIA ST
AURORA CO
80010-1517
US

IV. Provider business mailing address

2255 S ONEIDA ST
DENVER CO
80224-2522
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax:
Mailing address:
  • Phone: 303-360-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1662332
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0997274-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: