Healthcare Provider Details

I. General information

NPI: 1801140488
Provider Name (Legal Business Name): LORI D PEARSON KRAMER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ALAMEDA ST STE 25
SANTA FE NM
87501-1673
US

IV. Provider business mailing address

901 W ALAMEDA ST STE 25
SANTA FE NM
87501-1673
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-6132
  • Fax: 505-982-6298
Mailing address:
  • Phone: 505-988-8869
  • Fax: 505-982-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number645
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: