Healthcare Provider Details

I. General information

NPI: 1487710596
Provider Name (Legal Business Name): CONNIE L KOSHEWA L.M, C.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WELLESLEY DR SE
ALBUQUERQUE NM
87106-1443
US

IV. Provider business mailing address

21 GARDEN PARK CIR NW
ALBUQUERQUE NM
87107-2655
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-5762
  • Fax: 505-268-7500
Mailing address:
  • Phone: 505-293-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number04008R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: