Healthcare Provider Details

I. General information

NPI: 1346572856
Provider Name (Legal Business Name): LINDSAY DIANE WILBANKS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE B7500
FT. CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2164
  • Fax: 719-526-7850
Mailing address:
  • Phone: 719-524-2164
  • Fax: 719-526-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60138928
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: