Healthcare Provider Details

I. General information

NPI: 1770372351
Provider Name (Legal Business Name): LUMA NOVA LEARNING CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

406 S LEA AVE
ROSWELL NM
88203-4564
US

IV. Provider business mailing address

406 S LEA AVE
ROSWELL NM
88203-4564
US

V. Phone/Fax

Practice location:
  • Phone: 575-243-5001
  • Fax: 575-616-7006
Mailing address:
  • Phone: 575-243-5001
  • Fax: 575-616-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: KALEB PULTS
Title or Position: TREASURER
Credential:
Phone: 575-243-5001