Provider Demographics
NPI:1790168425
Name:SERIKI, DEMETRA
Entity Type:Individual
Prefix:
First Name:DEMETRA
Middle Name:
Last Name:SERIKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 ACADEMY CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1694
Mailing Address - Country:US
Mailing Address - Phone:719-425-2631
Mailing Address - Fax:877-278-2590
Practice Address - Street 1:2130 ACADEMY CIR
Practice Address - Street 2:SUITE D
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1694
Practice Address - Country:US
Practice Address - Phone:719-425-2631
Practice Address - Fax:877-278-2590
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMRW176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife