Healthcare Provider Details

I. General information

NPI: 1720714884
Provider Name (Legal Business Name): BEYOND BIRTH ABQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 CHARLESTON ST NE
ALBUQUERQUE NM
87110-3608
US

IV. Provider business mailing address

2720 CHARLESTON ST NE
ALBUQUERQUE NM
87110-3608
US

V. Phone/Fax

Practice location:
  • Phone: 505-818-8040
  • Fax:
Mailing address:
  • Phone: 505-818-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE J YANKE
Title or Position: PRESIDENT
Credential: CNM, CPNP-PC, IBCLC
Phone: 505-818-8040