Provider Demographics
NPI:1396733358
Name:LECLAIR, EMILY M (CNM)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:M
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-1118
Mailing Address - Fax:719-526-7850
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPTIAL OB/GYN
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-1118
Practice Address - Fax:719-526-7850
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO116645367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07116643Medicaid
COP23763Medicare UPIN