Healthcare Provider Details

I. General information

NPI: 1386204287
Provider Name (Legal Business Name): TIRSA EAGER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 STANFORD DR SE
ALBUQUERQUE NM
87106-3543
US

IV. Provider business mailing address

415 STANFORD DR SE
ALBUQUERQUE NM
87106-3543
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-9653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19191R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: