Healthcare Provider Details

I. General information

NPI: 1285966838
Provider Name (Legal Business Name): JESSICA MAUREEN FRECHETTE-GUTFREUND LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 LA JOYA ST STE A
ESPANOLA NM
87532-2233
US

IV. Provider business mailing address

PO BOX 157
ESPANOLA NM
87532-0157
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-7209
  • Fax:
Mailing address:
  • Phone: 505-508-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number09065R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: