Healthcare Provider Details

I. General information

NPI: 1194989665
Provider Name (Legal Business Name): DONNA ANNE LEE LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10513 N VALLEY DR
LAS CRUCES NM
88007-6026
US

IV. Provider business mailing address

10513 N VALLEY DR
LAS CRUCES NM
88007-6026
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-0563
  • Fax:
Mailing address:
  • Phone: 575-202-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number08046R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: