Provider Demographics
NPI:1932593803
Name:COMMUNITY MIDWIFERY, LLC
Entity type:Organization
Organization Name:COMMUNITY MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSM, CPM, RM
Authorized Official - Phone:719-761-7541
Mailing Address - Street 1:2021 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3840
Mailing Address - Country:US
Mailing Address - Phone:719-761-7541
Mailing Address - Fax:
Practice Address - Street 1:2021 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3840
Practice Address - Country:US
Practice Address - Phone:719-761-7541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR.0000163176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty