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General NPI Number Information
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NPI Number | 1144422148
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Entity Type | Organization
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Legal Business Name | NORTHERN NEW MEXICO BIRTH CENTER
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 1331 MAESTAS RD
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-758-1216
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Fax | 575-758-2683
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Provider Business Mailing Address
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Address Line | 1331 MAESTAS RD
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-758-1216
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Fax | 575-758-2683
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Authorized Official
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Title or Position | MIDWIFE
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Name | MRS. BOBBIE JEANETTE BOYD
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Credential | LM CPM
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Telephone | 575-758-1216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175M00000X
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Taxonomy Name | Lay Midwife
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 00405R
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 07038R
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 95297R
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License Number State | NM
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