Healthcare Provider Details

I. General information

NPI: 1780129403
Provider Name (Legal Business Name): SAMANTHA GALLEGOS-GOLLIHUGH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 405
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

201 CEDAR ST SE STE 405
ALBUQUERQUE NM
87106-4924
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-9535
  • Fax:
Mailing address:
  • Phone: 505-764-9535
  • Fax: 505-924-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: