Healthcare Provider Details

I. General information

NPI: 1700944089
Provider Name (Legal Business Name): LAURIE ANN HOLMES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST N 9A
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 2453
SANTA FE NM
87504
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1930
  • Fax: 505-982-9931
Mailing address:
  • Phone: 505-699-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number232
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: