Provider Demographics
NPI:1629196894
Name:ROBERTS, JUDITH ANNE (RM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 HUMBOLDT CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2339
Mailing Address - Country:US
Mailing Address - Phone:303-931-5727
Mailing Address - Fax:303-651-7614
Practice Address - Street 1:2807 HUMBOLDT CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-2339
Practice Address - Country:US
Practice Address - Phone:303-931-5727
Practice Address - Fax:303-651-7614
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50OtherMIDWIFE REGISTRY NUMBER