Provider Demographics
NPI:1154950111
Name:DONOHO, TATIA L (RM, CPM)
Entity type:Individual
Prefix:
First Name:TATIA
Middle Name:L
Last Name:DONOHO
Suffix:
Gender:F
Credentials:RM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BRIGGSDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80611-0036
Mailing Address - Country:US
Mailing Address - Phone:970-371-6455
Mailing Address - Fax:
Practice Address - Street 1:39256 COUNTY ROAD 80
Practice Address - Street 2:
Practice Address - City:BRIGGSDALE
Practice Address - State:CO
Practice Address - Zip Code:80611
Practice Address - Country:US
Practice Address - Phone:970-371-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000192176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife