Healthcare Provider Details

I. General information

NPI: 1821944307
Provider Name (Legal Business Name): MCKENNA DAWN MARIE MATINS BIRTH DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ADIRONDACK PL SE
ALBUQUERQUE NM
87123-3463
US

IV. Provider business mailing address

400 ADIRONDACK PL SE
ALBUQUERQUE NM
87123-3463
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-4764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number26002D
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: