Healthcare Provider Details

I. General information

NPI: 1790712248
Provider Name (Legal Business Name): JENNIFER HALI ENOCH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GONZALES RD SW
ALBUQUERQUE NM
87121-2401
US

IV. Provider business mailing address

1124 MONROE ST SE
ALBUQUERQUE NM
87108-4518
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4816
  • Fax: 505-272-3815
Mailing address:
  • Phone: 505-266-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN00163322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: