Provider Demographics
NPI:1699472944
Name:NEW, MICHELLE (CPM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEW
Suffix:
Gender:F
Credentials: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 118
Mailing Address - Street 2:
Mailing Address - City:PITKIN
Mailing Address - State:CO
Mailing Address - Zip Code:81241-0118
Mailing Address - Country:US
Mailing Address - Phone:970-975-0821
Mailing Address - Fax:
Practice Address - Street 1:116 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2624
Practice Address - Country:US
Practice Address - Phone:970-975-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM23010153176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPM23010153OtherNARM