Healthcare Provider Details

I. General information

NPI: 1164780128
Provider Name (Legal Business Name): HUMMINGBIRD MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 PACIFIC AVE SW
ALBUQUERQUE NM
87102-4166
US

IV. Provider business mailing address

413 PACIFIC AVE SW
ALBUQUERQUE NM
87102-4166
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1690
  • Fax:
Mailing address:
  • Phone: 505-262-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUSTEN MARIE
Title or Position: OFFICE MANAGER
Credential: LM
Phone: 505-262-1690