Healthcare Provider Details

I. General information

NPI: 1154950111
Provider Name (Legal Business Name): TATIA L DONOHO RM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39256 COUNTY ROAD 80
BRIGGSDALE CO
80611
US

IV. Provider business mailing address

PO BOX 36
BRIGGSDALE CO
80611-0036
US

V. Phone/Fax

Practice location:
  • Phone: 970-371-6455
  • Fax:
Mailing address:
  • Phone: 970-371-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number00000192
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: