Healthcare Provider Details

I. General information

NPI: 1548447543
Provider Name (Legal Business Name): COMMUNITY MIDWIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 NE AZTEC BLVD
AZTEC NM
87410-1706
US

IV. Provider business mailing address

755 E 2ND AVE
DURANGO CO
81301-5498
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-2626
  • Fax: 970-375-9053
Mailing address:
  • Phone: 970-385-2626
  • Fax: 970-375-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number84100-R
License Number StateNM

VIII. Authorized Official

Name: MS. JUANITA NELSON
Title or Position: OWNER/PARTNER
Credential: LM, RM, CPM
Phone: 970-385-2626