Healthcare Provider Details

I. General information

NPI: 1417453937
Provider Name (Legal Business Name): JANE AVERY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 05/31/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 DELAWARE ST
DENVER CO
80204-4532
US

IV. Provider business mailing address

790 DELAWARE ST
DENVER CO
80204-4532
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1641100
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0997276
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0997276
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: