Healthcare Provider Details

I. General information

NPI: 1194521294
Provider Name (Legal Business Name): SEDONA KOLCHINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7708 4TH ST NW
LOS RANCHOS NM
87107-6510
US

IV. Provider business mailing address

8100 BARSTOW ST NE APT 11202
ALBUQUERQUE NM
87122-2872
US

V. Phone/Fax

Practice location:
  • Phone: 150-592-4222
  • Fax:
Mailing address:
  • Phone: 856-437-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number907
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM09996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: