Healthcare Provider Details

I. General information

NPI: 1871773887
Provider Name (Legal Business Name): MELISSA MARIE BAILEY L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
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: 575-541-6187
Mailing address:
  • Phone: 575-541-6177
  • Fax: 575-541-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number05021R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: