=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245274380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY SMITH CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 10/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2559 MEDICAL DR SUITE D
-----------------------------------------------------
City | ALAMOGORDO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88310-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-434-2229
-----------------------------------------------------
Fax | 505-439-5705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2559 MEDICAL DR SUITE D
-----------------------------------------------------
City | ALAMOGORDO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88310-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-434-2229
-----------------------------------------------------
Fax | 505-439-5705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 496
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------