Healthcare Provider Details

I. General information

NPI: 1639080898
Provider Name (Legal Business Name): FAITH ELIZABETH LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 KAYENTA DR
FARMINGTON NM
87402-5232
US

IV. Provider business mailing address

3500 KAYENTA DR
FARMINGTON NM
87402-5232
US

V. Phone/Fax

Practice location:
  • Phone: 505-595-1112
  • Fax:
Mailing address:
  • Phone: 505-595-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-2156
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number91672
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number26043D
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: