MEDICARE: BEATRICE WILDS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1760804553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE WILDS

Provider Business Mailing Address
First Line	:	115 W COLUMBIA ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7321
Country	:	US
Telephone Number	:	719-660-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 W COLORADO AVE STE 301
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-6017
Country	:	US
Telephone Number	:	719-660-5687
Fax Number	:

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

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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Directions to “ BEATRICE WILDS ” Practice Location

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