Healthcare Provider Details

I. General information

NPI: 1255511325
Provider Name (Legal Business Name): CIRCLE OF THE SOLITARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N MAIN ST
LAS CRUCES NM
88001-1102
US

IV. Provider business mailing address

1210 N MAIN ST
LAS CRUCES NM
88001-1102
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-6177
  • Fax: 505-541-6187
Mailing address:
  • Phone: 575-541-6177
  • Fax: 505-541-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number96320 R
License Number StateNM

VIII. Authorized Official

Name: MS. KIMBERLY C SHAW
Title or Position: CFO
Credential: MIM, MAAC, CIA, EA
Phone: 915-562-9223