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General NPI Number Information
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NPI Number | 1124666417
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Entity Type | Organization
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Legal Business Name | BLUE SPRUCE BIRTH AND WELLNESS LLC
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 5803 MCWHINNEY BLVD
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City | LOVELAND
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State | CO
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Zip | 80538-8829
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Country | US
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Telephone | 970-699-5990
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Fax | 970-699-5998
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Provider Business Mailing Address
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Address Line | 2110 BUFFALO MOUNTAIN PL
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City | LOVELAND
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State | CO
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Zip | 80538-8780
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Country | US
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Telephone | 970-699-5990
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Fax | 970-699-5998
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Authorized Official
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Title or Position | CNM/OWNER
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Name | RONYA GENINE LEGGE KONECNY
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Credential | CNM
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Telephone | 970-699-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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