Healthcare Provider Details

I. General information

NPI: 1760804553
Provider Name (Legal Business Name): BEATRICE WILDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 W COLORADO AVE STE 301
COLORADO SPRINGS CO
80904-6017
US

IV. Provider business mailing address

115 W COLUMBIA ST
COLORADO SPRINGS CO
80907-7321
US

V. Phone/Fax

Practice location:
  • Phone: 719-660-5687
  • Fax:
Mailing address:
  • Phone: 719-660-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: