Healthcare Provider Details

I. General information

NPI: 1639192826
Provider Name (Legal Business Name): DOROTHY D BEACH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 301
ALBUQUERQUE NM
87109-1226
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE STE 301
ALBUQUERQUE NM
87109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4500
  • Fax: 505-727-4505
Mailing address:
  • Phone: 505-727-4500
  • Fax: 505-727-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number331
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: