Healthcare Provider Details

I. General information

NPI: 1649295221
Provider Name (Legal Business Name): VIRGINIA LOU CRANDALL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 BARNES ROAD
COLORADO SPRINGS CO
80922
US

IV. Provider business mailing address

2 SOUTH CASCADE AVENUE SUITE 140
COLORADO SPRINGS CO
80903-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-380-5411
  • Fax: 719-390-3571
Mailing address:
  • Phone: 719-538-2900
  • Fax: 719-538-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number169985
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: