Healthcare Provider Details

I. General information

NPI: 1083708473
Provider Name (Legal Business Name): GAIL L ROTHFORK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SAN MATEO BLVD SE PMG SAN MATEO
ALBUQUERQUE NM
87108-2921
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7306
  • Fax: 505-462-7495
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number474
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number474
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: