Healthcare Provider Details

I. General information

NPI: 1871518803
Provider Name (Legal Business Name): MARY PAGE SMITH CNM, OB-GYN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30772 SOUTHVIEW DR. STE 120
EVERGREEN CO
80439
US

IV. Provider business mailing address

30772 SOUTHVIEW DR. STE 120
EVERGREEN CO
80439
US

V. Phone/Fax

Practice location:
  • Phone: 303-670-3931
  • Fax:
Mailing address:
  • Phone: 303-670-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100795
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number100795
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number100795
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number100795
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: