Healthcare Provider Details

I. General information

NPI: 1689244055
Provider Name (Legal Business Name): SZODYRAA SMITH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COAL AVE SE
ALBUQUERQUE NM
87106-5205
US

IV. Provider business mailing address

6320 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6168
  • Fax:
Mailing address:
  • Phone: 505-843-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number928
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: