MEDICARE: MRS. EMILY M LECLAIR CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	116645	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396733358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY M LECLAIR CNM

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:	EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-1118
Fax Number	:	719-526-7850

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:	EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-1118
Fax Number	:	719-526-7850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	03/13/2013

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