Healthcare Provider Details

I. General information

NPI: 1790168425
Provider Name (Legal Business Name): DEMETRA SERIKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 ACADEMY CIR SUITE D
COLORADO SPRINGS CO
80909-1694
US

IV. Provider business mailing address

2130 ACADEMY CIR SUITE D
COLORADO SPRINGS CO
80909-1694
US

V. Phone/Fax

Practice location:
  • Phone: 719-425-2631
  • Fax: 877-278-2590
Mailing address:
  • Phone: 719-425-2631
  • Fax: 877-278-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: