Healthcare Provider Details

I. General information

NPI: 1073298931
Provider Name (Legal Business Name): BOULDER BIRTH & HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 FOLSOM ST STE C
BOULDER CO
80304-3768
US

IV. Provider business mailing address

2800 FOLSOM ST STE C
BOULDER CO
80304-3768
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ABRIE KOUPAL
Title or Position: CLINICAL DIRECTOR
Credential: CNM
Phone: 970-903-1802