Provider Demographics
NPI:1376522201
Name:VIEIRA, LINDA P (CNM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0111
Mailing Address - Country:US
Mailing Address - Phone:970-945-1443
Mailing Address - Fax:970-947-9410
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:#103
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1648
Practice Address - Country:US
Practice Address - Phone:970-925-8005
Practice Address - Fax:970-920-1652
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59380367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07593809Medicaid
VI159638OtherBLUE CROSS
VI159638OtherBLUE CROSS