Healthcare Provider Details

I. General information

NPI: 1780323980
Provider Name (Legal Business Name): BRECKLEN ABLES CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRECKLEN JONES

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 JESSUP DR
FORT COLLINS CO
80525-2550
US

IV. Provider business mailing address

1817 JESSUP DR
FORT COLLINS CO
80525-2550
US

V. Phone/Fax

Practice location:
  • Phone: 866-218-5769
  • Fax: 866-218-8576
Mailing address:
  • Phone: 866-218-5769
  • Fax: 866-218-8576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMWR.0000214
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: