Healthcare Provider Details

I. General information

NPI: 1780363002
Provider Name (Legal Business Name): ELIZABETH ASHLEY JAFFA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE STE 301
ALBUQUERQUE NM
87109-1234
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE STE 301
ALBUQUERQUE NM
87109-1234
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7800
  • Fax:
Mailing address:
  • Phone: 505-727-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number854
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: