Provider Demographics
NPI:1548447543
Name:COMMUNITY MIDWIVES LLC
Entity type:Organization
Organization Name:COMMUNITY MIDWIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, RM, CPM
Authorized Official - Phone:970-385-2626
Mailing Address - Street 1:755 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5498
Mailing Address - Country:US
Mailing Address - Phone:970-385-2626
Mailing Address - Fax:970-375-9053
Practice Address - Street 1:603 NE AZTEC BLVD
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-1706
Practice Address - Country:US
Practice Address - Phone:970-385-2626
Practice Address - Fax:970-375-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84100-R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty