Healthcare Provider Details

I. General information

NPI: 1346444254
Provider Name (Legal Business Name): NORTHERN NEW MEXICO BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 MAESTAS RD
TAOS NM
87571-6268
US

IV. Provider business mailing address

1331 MAESTAS RD
TAOS NM
87571-6268
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-1216
  • Fax: 505-758-2683
Mailing address:
  • Phone: 505-758-1216
  • Fax: 505-758-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOAN DARBY NORRIS
Title or Position: DIRECTOR AND MIDWIFE
Credential: CPM, LM
Phone: 505-758-1216