Healthcare Provider Details

I. General information

NPI: 1346387511
Provider Name (Legal Business Name): TRACY E RYAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S LAFAYETTE ST STE 100
ENGLEWOOD CO
80113-3954
US

IV. Provider business mailing address

2902 ZUNI ST
DENVER CO
80211-3827
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-0600
  • Fax: 303-788-0602
Mailing address:
  • Phone: 720-515-7617
  • Fax: 303-484-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN160693
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: