Healthcare Provider Details

I. General information

NPI: 1053123539
Provider Name (Legal Business Name): JILLIAN SARAH MICHALENKO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
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

2 MARSHALL RD
PITTSBURGH PA
15214-2602
US

V. Phone/Fax

Practice location:
  • Phone: 719-367-9405
  • Fax:
Mailing address:
  • Phone: 724-809-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: