Healthcare Provider Details

I. General information

NPI: 1871847046
Provider Name (Legal Business Name): NATURAL BIRTH MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
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

123 WELLESLEY DR SE
ALBUQUERQUE NM
87106-1443
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CONNIE KOSHEWA
Title or Position: OWNER
Credential: LM, CPM, MPH
Phone: 505-266-5762