Healthcare Provider Details

I. General information

NPI: 1760092308
Provider Name (Legal Business Name): MIKALA TRUMBO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKALA KOSTER

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 G RD STE 240
GRAND JUNCTION CO
81505-1006
US

IV. Provider business mailing address

PO BOX 1727
GRAND JCT CO
81502-1727
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-7908
  • Fax: 970-245-0656
Mailing address:
  • Phone: 970-243-7908
  • Fax: 970-245-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPN.0995313
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN.0995313
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: