Provider Demographics
NPI:1124666417
Name:BLUE SPRUCE BIRTH AND WELLNESS LLC
Entity type:Organization
Organization Name:BLUE SPRUCE BIRTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONYA
Authorized Official - Middle Name:GENINE
Authorized Official - Last Name:LEGGE KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:970-699-5990
Mailing Address - Street 1:2110 BUFFALO MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8780
Mailing Address - Country:US
Mailing Address - Phone:970-699-5990
Mailing Address - Fax:970-699-5998
Practice Address - Street 1:5803 MCWHINNEY BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8829
Practice Address - Country:US
Practice Address - Phone:970-699-5990
Practice Address - Fax:970-699-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000173512Medicaid