Healthcare Provider Details

I. General information

NPI: 1528912912
Provider Name (Legal Business Name): ELIZABETH VITRY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date: 08/14/2026
Reactivation Date: 09/16/2026

III. Provider practice location address

2781 S FENTON ST
DENVER CO
80227-4100
US

IV. Provider business mailing address

2781 S FENTON ST
DENVER CO
80227-4100
US

V. Phone/Fax

Practice location:
  • Phone: 720-207-8292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMWR.0000258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: