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General NPI Number Information
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NPI Number | 1548797921
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Entity Type | Individual
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Provider Name | MARIA GRACE DOMINGUE CNM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 08/06/2017
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Provider Practice Location Address
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Address Line | 180 E HAMPDEN AVE STE 100
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2517
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Country | US
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Telephone | 303-789-4968
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Fax |
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Provider Business Mailing Address
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Address Line | 5798 S GALLUP ST APT 105
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City | LITTLETON
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State | CO
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Zip | 80120-2134
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Country | US
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Telephone | 303-587-1107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 1633033
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APN.0993226-CNM
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License Number State | CO
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