Healthcare Provider Details

I. General information

NPI: 1144748823
Provider Name (Legal Business Name): BURGEON BIRTH-N-LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
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: 866-730-6883
Mailing address:
  • Phone: 505-459-1901
  • Fax: 866-730-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number15136R
License Number StateNM

VIII. Authorized Official

Name: KAREN A QUIGLEY-TREJO
Title or Position: OWNER
Credential: LM,IBCLC
Phone: 505-459-1901