Healthcare Provider Details

I. General information

NPI: 1831979699
Provider Name (Legal Business Name): SALLY MAXWELL DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
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: 505-795-6600
  • Fax:
Mailing address:
  • Phone: 505-795-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: