Healthcare Provider Details

I. General information

NPI: 1396822128
Provider Name (Legal Business Name): SHERI ANNE RAPHAELSON L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PASEO DE ONATE
ESPANOLA NM
87532-3521
US

IV. Provider business mailing address

PO BOX 248
ESPANOLA NM
87532-0248
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-3831
  • Fax: 505-753-3468
Mailing address:
  • Phone: 505-747-3831
  • Fax: 505-753-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number92229R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: