Provider Demographics
NPI:1720021215
Name:FIELDS, JENNIFER Y (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:Y
Last Name:FIELDS
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 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-320-2944
Mailing Address - Fax:303-320-2947
Practice Address - Street 1:4545 E. 9TH AVE
Practice Address - Street 2:#502
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3910
Practice Address - Country:US
Practice Address - Phone:303-320-2944
Practice Address - Fax:303-320-2947
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124408367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60153326Medicaid
Q30892Medicare UPIN
CO60153326Medicaid
COC800463Medicare PIN