Healthcare Provider Details

I. General information

NPI: 1891852240
Provider Name (Legal Business Name): CENTER FOR PRENATAL DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE STE. 106
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE STE. 106
ALBUQUERQUE NM
87109-2129
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-5657
  • Fax: 505-883-5322
Mailing address:
  • Phone: 505-883-5657
  • Fax: 505-883-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number96-270
License Number StateNM

VIII. Authorized Official

Name: DR. STEPHANIE HEDSTROM
Title or Position: OWNER
Credential: MD
Phone: 505-883-5657