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General NPI Number Information
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NPI Number | 1932593803
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Entity Type | Organization
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Legal Business Name | COMMUNITY MIDWIFERY, LLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 2021 W COLORADO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-3840
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Country | US
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Telephone | 719-761-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 W COLORADO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-3840
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Country | US
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Telephone | 719-761-7541
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Fax |
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Authorized Official
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Title or Position | OWNER, MIDWIFE
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Name | MAREN J FULLER
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Credential | MSM, CPM, RM
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Telephone | 719-761-7541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MWR.0000163
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License Number State | CO
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