Healthcare Provider Details

I. General information

NPI: 1700749967
Provider Name (Legal Business Name): MAGPIE DOULA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LOPEZ ST
SANTA FE NM
87501-2422
US

IV. Provider business mailing address

1011 LOPEZ ST
SANTA FE NM
87501-2422
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-3412
  • Fax:
Mailing address:
  • Phone: 505-819-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: SALLY MAXWELL
Title or Position: DOULA
Credential:
Phone: 505-819-3412