Provider Demographics
NPI:1265799787
Name:STEPHEN, TARA LESLIE (CPM)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LESLIE
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 SILVER PONDS HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4765
Mailing Address - Country:US
Mailing Address - Phone:719-330-1851
Mailing Address - Fax:719-494-2238
Practice Address - Street 1:7120 SILVER PONDS HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-4765
Practice Address - Country:US
Practice Address - Phone:719-330-1851
Practice Address - Fax:719-494-2238
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife