Healthcare Provider Details

I. General information

NPI: 1568855419
Provider Name (Legal Business Name): KAREN QUIGLEY-TREJO L.M., I.B.C.L.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-1935
US

IV. Provider business mailing address

901 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-1935
US

V. Phone/Fax

Practice location:
  • Phone: 505-459-1901
  • Fax: 877-500-7949
Mailing address:
  • Phone: 505-459-1901
  • Fax: 866-730-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number15136-R
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11127253
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: