Healthcare Provider Details

I. General information

NPI: 1578042958
Provider Name (Legal Business Name): REBECCA ANN ARCHULETA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 05/22/2024
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SPRUCE ST FL 3
ESPANOLA NM
87532-2724
US

IV. Provider business mailing address

1010 SPRUCE ST FL 3
ESPANOLA NM
87532-2724
US

V. Phone/Fax

Practice location:
  • Phone: 505-367-0340
  • Fax: 505-367-0326
Mailing address:
  • Phone: 505-367-0340
  • Fax: 505-367-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number747
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: