Provider Demographics
NPI:1760114391
Name:JANES, ELISA (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:JANES
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7875
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80933-7875
Mailing Address - Country:US
Mailing Address - Phone:719-428-5552
Mailing Address - Fax:719-687-9519
Practice Address - Street 1:3803 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4828
Practice Address - Country:US
Practice Address - Phone:719-428-5552
Practice Address - Fax:719-687-9519
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997696-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife