MEDICARE: ELISA JANES MSN, 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	APN.0997696-CNM	CO

General Provider Information

NPI Number	:	1760114391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA JANES MSN, CNM

Provider Business Mailing Address
First Line	:	PO BOX 7875
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80933-7875
Country	:	US
Telephone Number	:	719-428-5552
Fax Number	:	719-687-9519

Provider Business Practice Location Address
First Line	:	3803 MANCHESTER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4828
Country	:	US
Telephone Number	:	719-428-5552
Fax Number	:	719-687-9519

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

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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