Healthcare Provider Details

I. General information

NPI: 1578863627
Provider Name (Legal Business Name): ELIZABETH MARY DERRY CPM,LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 E VASSAR DR APT E109
DENVER CO
80231-5905
US

IV. Provider business mailing address

9888 E VASSAR DR APT E109
DENVER CO
80231-5905
US

V. Phone/Fax

Practice location:
  • Phone: 720-605-2333
  • Fax: 888-810-9658
Mailing address:
  • Phone: 720-605-2333
  • Fax: 888-810-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99110
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number16156R
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMWR.0000242
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: