Healthcare Provider Details

I. General information

NPI: 1538381116
Provider Name (Legal Business Name): SUSAN MICHELE TRUJILLO REGISTERED MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SHERMAN AVE
CANON CITY CO
81212-4384
US

IV. Provider business mailing address

1607 SHERMAN AVE
CANON CITY CO
81212-4384
US

V. Phone/Fax

Practice location:
  • Phone: 719-276-6856
  • Fax:
Mailing address:
  • Phone: 719-276-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number72
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: