Healthcare Provider Details

I. General information

NPI: 1093437881
Provider Name (Legal Business Name): IVORY MELIKA SCHWABEROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILLOW ST
DENVER CO
80238-3372
US

IV. Provider business mailing address

3455 WILLOW ST
DENVER CO
80238-3372
US

V. Phone/Fax

Practice location:
  • Phone: 303-880-2808
  • Fax:
Mailing address:
  • Phone: 303-880-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number334970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: