MEDICARE: MS. ELLEN LUDWIG LICENSED MIDWIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	L13701	NM
2	176B00000X	Midwife	04004R	NM

General Provider Information

NPI Number	:	1013241975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN LUDWIG LICENSED MIDWIFE

Provider Business Mailing Address
First Line	:	1005 SIRINGO RONDO E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5015
Country	:	US
Telephone Number	:	505-473-0246
Fax Number	:	505-753-0599

Provider Business Practice Location Address
First Line	:	1005 SIRINGO RONDO E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5015
Country	:	US
Telephone Number	:	505-473-0246
Fax Number	:	505-753-0599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	07/10/2013

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