Healthcare Provider Details

I. General information

NPI: 1023248671
Provider Name (Legal Business Name): REBECCA LYNNE ROSE CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MCMANUS RD
NEW HAMPTON NY
10958-3510
US

IV. Provider business mailing address

215 8TH ST SW
ALBUQUERQUE NM
87102-3003
US

V. Phone/Fax

Practice location:
  • Phone: 505-514-3532
  • Fax:
Mailing address:
  • Phone: 505-254-7615
  • Fax: 505-242-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number09055R
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316346
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: