Healthcare Provider Details

I. General information

NPI: 1386878007
Provider Name (Legal Business Name): ANNA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2009
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 FOLSOM ST
BOULDER CO
80304-3738
US

IV. Provider business mailing address

836 SUMNER ST
LONGMONT CO
80501-4837
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-3993
  • Fax:
Mailing address:
  • Phone: 734-395-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: