Healthcare Provider Details

I. General information

NPI: 1154450229
Provider Name (Legal Business Name): TERRI LYNN SIMMONS LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 MEADOW RD SW
ALBUQUERQUE NM
87105-4916
US

IV. Provider business mailing address

2303 MEADOW RD SW
ALBUQUERQUE NM
87105-4916
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-6116
  • Fax:
Mailing address:
  • Phone: 505-243-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number00408R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: