Healthcare Provider Details

I. General information

NPI: 1760624779
Provider Name (Legal Business Name): ELAINE LOUISE BRIGHTWATER DNP, CNM, WHCNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 SANTA CLARA AVE SE
ALBUQUERQUE NM
87106-3041
US

IV. Provider business mailing address

2726 SANTA CLARA AVE SE
ALBUQUERQUE NM
87106-3041
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-6642
  • Fax:
Mailing address:
  • Phone: 505-228-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number364
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: