Healthcare Provider Details

I. General information

NPI: 1588800205
Provider Name (Legal Business Name): RIO GRANDE MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 4TH ST NW
ALBUQUERQUE NM
87107-3949
US

IV. Provider business mailing address

4916 4TH ST NW
ALBUQUERQUE NM
87107-3949
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2922
  • Fax: 505-345-2922
Mailing address:
  • Phone: 505-345-2922
  • Fax: 505-345-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number95286R
License Number StateNM

VIII. Authorized Official

Name: MS. MARY L SINGLETON
Title or Position: MIDWIFE
Credential: CPM
Phone: 505-344-1939