Healthcare Provider Details

I. General information

NPI: 1649525189
Provider Name (Legal Business Name): ANDREA M HILL LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
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

1876 TIOVIVO CIR NW
ALBUQUERQUE NM
87107-2832
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-8715
  • Fax:
Mailing address:
  • Phone: 505-238-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number12098R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: