Healthcare Provider Details

I. General information

NPI: 1780126433
Provider Name (Legal Business Name): BREATH OF MY HEART BIRTHPLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CALLE ARMADA
ESPANOLA NM
87532
US

IV. Provider business mailing address

905 CALLE ARMADA
ESPANOLA NM
87532
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-0505
  • Fax: 505-212-0420
Mailing address:
  • Phone: 505-753-0505
  • Fax: 505-212-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE A TSOSIE
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 505-753-0505