Basic Information
| Provider Information | |||||||||
| NPI: | 1215925284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS LUNDGREN | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6071 E WOODMEN RD | ||||||||
| Address2: | STE 405 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809232614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038735245 | ||||||||
| FaxNumber: | 3038735240 | ||||||||
| Practice Location | |||||||||
| Address1: | 6071 E WOODMEN RD STE 405 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809232614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194420808 | ||||||||
| FaxNumber: | 7196223400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1827 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 07781487 | 05 | CO | MEDICAID |