Basic Information
| Provider Information | |||||||||
| NPI: | 1235178880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 58TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704950444 | ||||||||
| FaxNumber: | 9702249624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 58TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806344808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704950444 | ||||||||
| FaxNumber: | 9702249624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNM-173 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 07897721 | 05 | CO | MEDICAID |