Healthcare Provider Details

I. General information

NPI: 1518945708
Provider Name (Legal Business Name): NANCY LOUISE BRANNIN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HOT SPRINGS BLVD STE A
LAS VEGAS NM
87701-3481
US

IV. Provider business mailing address

918 5TH ST
LAS VEGAS NM
87701-4332
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6425
  • Fax: 505-425-6475
Mailing address:
  • Phone: 505-426-8646
  • Fax: 505-425-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number528
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: