Healthcare Provider Details

I. General information

NPI: 1396733358
Provider Name (Legal Business Name): EMILY M LECLAIR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-1118
  • Fax: 719-526-7850
Mailing address:
  • Phone: 719-526-1118
  • Fax: 719-526-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number116645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: