Provider Demographics
NPI:1902042393
Name:BROPHY, STACEY DYAN (CNM)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DYAN
Last Name:BROPHY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:NEARHOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-322-2240
Mailing Address - Fax:303-322-9260
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:#140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-322-2240
Practice Address - Fax:303-322-9260
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5867367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1902042393Medicaid
CO07788819Medicaid
NE10025711400Medicaid
CO63223082Medicaid
NE10025711400Medicaid