Healthcare Provider Details

I. General information

NPI: 1972583839
Provider Name (Legal Business Name): DELINA J. BURKE MPH, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELINA HOLMES, FOSS

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 NIZHONI BLVD
GALLUP NM
87301-5757
US

IV. Provider business mailing address

3204 BLUE HILL AVE
GALLUP NM
87301-6933
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax:
Mailing address:
  • Phone: 505-863-8144
  • Fax: 505-863-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number027306-23-01
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: