Healthcare Provider Details

I. General information

NPI: 1821612136
Provider Name (Legal Business Name): BIRTH WITH JOY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BENDITA LOMA
LOS LUNAS NM
87031-6897
US

IV. Provider business mailing address

24 BENDITA LOMA
LOS LUNAS NM
87031-6897
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-1947
  • Fax: 505-672-7065
Mailing address:
  • Phone: 505-358-1947
  • Fax: 505-672-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: JOY L HARRIS
Title or Position: BUSINESS OWNER
Credential: LM
Phone: 505-358-1947