Healthcare Provider Details

I. General information

NPI: 1497580278
Provider Name (Legal Business Name): ASHLEY MICHELLE ELLIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 BRIAR VILLAGE PT STE 100
COLORADO SPRINGS CO
80920-7902
US

IV. Provider business mailing address

5808 BRAVE EAGLE DR
COLORADO SPRINGS CO
80924-2011
US

V. Phone/Fax

Practice location:
  • Phone: 719-367-9405
  • Fax:
Mailing address:
  • Phone: 916-342-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.1000192-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: