Healthcare Provider Details

I. General information

NPI: 1053437319
Provider Name (Legal Business Name): ANGELA MARIE ANSELMO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PROFESSIONAL LN UNIT 200
LONGMONT CO
80501-6964
US

IV. Provider business mailing address

1551 PROFESSIONAL LN UNIT 200
LONGMONT CO
80501-6964
US

V. Phone/Fax

Practice location:
  • Phone: 303-315-0400
  • Fax: 303-724-5550
Mailing address:
  • Phone: 303-315-0400
  • Fax: 303-724-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number185876
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: