Provider Demographics
NPI:1659304145
Name:INGLIS, CAROLE (CNM)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:INGLIS
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 1:1905 BLAKE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4288
Mailing Address - Country:US
Mailing Address - Phone:970-928-7727
Mailing Address - Fax:970-928-7727
Practice Address - Street 1:1905 BLAKE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4288
Practice Address - Country:US
Practice Address - Phone:970-928-7727
Practice Address - Fax:970-928-7727
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM523367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM86670883Medicaid
Q40951Medicare UPIN
NM348511005Medicare ID - Type Unspecified