Basic Information
| Provider Information | |||||||||
| NPI: | 1841219516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAFF LOGAN | ||||||||
| FirstName: | NOELLE | ||||||||
| MiddleName: | GARCIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038735245 | ||||||||
| FaxNumber: | 3038735240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S POTOMAC ST | ||||||||
| Address2: | #225 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800124514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038735245 | ||||||||
| FaxNumber: | 3038735240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/14/2013 | ||||||||
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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 | 176B00000X | 2070 | CO | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 07105034 | 05 | CO | MEDICAID |