Healthcare Provider Details

I. General information

NPI: 1396652004
Provider Name (Legal Business Name): REBEKAH ANDRUS NELSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 4TH ST NW
ALBUQUERQUE NM
87107-3949
US

IV. Provider business mailing address

4916 4TH ST NW
ALBUQUERQUE NM
87107-3949
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-2222
  • Fax:
Mailing address:
  • Phone: 505-450-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number932
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: