Healthcare Provider Details

I. General information

NPI: 1538316914
Provider Name (Legal Business Name): JACQUELYN J HITES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HIGH ST #140
DENVER CO
80205-5504
US

IV. Provider business mailing address

4900 S MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-2240
  • Fax: 303-322-9260
Mailing address:
  • Phone: 303-322-2240
  • Fax: 303-322-9260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1739
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: