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General NPI Number Information
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NPI Number | 1700174133
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Entity Type | Organization
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Legal Business Name | SOPRIS WOMEN'S CLINIC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 410 20TH ST STE 102
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4271
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Country | US
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Telephone | 970-355-9686
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Fax |
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Provider Business Mailing Address
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Address Line | 410 20TH ST STE 102
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4271
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Country | US
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Telephone | 970-355-9686
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Fax |
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Authorized Official
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Title or Position | OWNER, LLC
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Name | LISA TREADWAY
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Credential | CNM
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Telephone | 970-355-9686
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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 | 123427
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License Number State | CO
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