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General NPI Number Information
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NPI Number | 1295023893
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Entity Type | Organization
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Legal Business Name | THIRTEENTH MOON MIDWIFERY
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Dates
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Enumeration Date | 07/16/2011
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 2614 W VINE DR
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City | FORT COLLINS
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State | CO
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Zip | 80521-1504
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Country | US
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Telephone | 970-227-3555
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Fax | 970-822-0455
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Provider Business Mailing Address
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Address Line | 2614 W VINE DR
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City | FORT COLLINS
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State | CO
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Zip | 80521-1504
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Country | US
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Telephone | 970-227-3555
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Fax | 970-822-0455
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Authorized Official
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Title or Position | CNM/OWNER
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Name | CAROL ROEDOCKER
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Credential |
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Telephone | 970-227-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | RN118053
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License Number State | CO
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