Provider Demographics
NPI:1649295221
Name:CRANDALL, VIRGINIA LOU (CNM)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LOU
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:2 SOUTH CASCADE AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:719-538-2961
Practice Address - Street 1:6340 BARNES ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922
Practice Address - Country:US
Practice Address - Phone:719-380-5411
Practice Address - Fax:719-390-3571
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO169985367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19478836Medicaid