Healthcare Provider Details

I. General information

NPI: 1003759101
Provider Name (Legal Business Name): TRINITY STATE KIRILLOV CPM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 WESTMORELAND RD
COLORADO SPRINGS CO
80907-4858
US

IV. Provider business mailing address

5937 WARE ST APT E
COLORADO SPRINGS CO
80902-2134
US

V. Phone/Fax

Practice location:
  • Phone: 719-394-9779
  • Fax:
Mailing address:
  • Phone: 719-757-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMWR.0000253
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: