Provider Demographics
NPI:1760092308
Name:TRUMBO, MIKALA (CNM)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:TRUMBO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MIKALA
Other - Middle Name:
Other - Last Name:KOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-243-7908
Mailing Address - Fax:970-245-0656
Practice Address - Street 1:2373 G RD STE 240
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-7908
Practice Address - Fax:970-245-0656
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995313176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife