Healthcare Provider Details

I. General information

NPI: 1306960174
Provider Name (Legal Business Name): JULIE GREGORY GORWODA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5580 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

6629 ELWOOD DR NW
LOS RANCHOS DE ALBUQUERQUE NM
87107-6106
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4051
  • Fax: 505-272-6385
Mailing address:
  • Phone: 505-344-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number225
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: