Provider Demographics
NPI:1760410633
Name:COLE, ALICE M (CNM)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-2936
Mailing Address - Fax:719-538-2961
Practice Address - Street 1:2 S CASCADE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-538-2936
Practice Address - Fax:719-538-2961
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO105269367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24777552Medicaid
COP90991Medicare UPIN
CO24777552Medicaid