Healthcare Provider Details

I. General information

NPI: 1194270272
Provider Name (Legal Business Name): ANIDARABQ MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
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

PO BOX 8035
ALBUQUERQUE NM
87198-8035
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-9296
  • Fax:
Mailing address:
  • Phone: 505-688-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number537
License Number StateNM

VIII. Authorized Official

Name: CLAIRE BETTLER
Title or Position: CNM
Credential: CNM
Phone: 505-688-9296