Healthcare Provider Details

I. General information

NPI: 1801124813
Provider Name (Legal Business Name): COLLEEN ROSE FOX CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN ROSE MCCANN

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524B BISHOPS LODGE RD
SANTA FE NM
87506-0209
US

IV. Provider business mailing address

PO BOX 449
TESUQUE NM
87574-0449
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-6158
  • Fax:
Mailing address:
  • Phone: 541-678-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number620965-90
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: