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General NPI Number Information
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NPI Number | 1285633412
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Entity Type | Individual
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Provider Name | AMY JO WAYEA DOUGHTY CNM
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ROUTE 301 NORTH 'B' STREET
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City | ZUNI
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State | NM
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Zip | 87327-0467
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Country | US
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Telephone | 505-782-4431
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Fax | 505-782-7551
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | ZUNI
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State | NM
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Zip | 87327-0467
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Country | US
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Telephone | 505-782-4431
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Fax | 505-782-7551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | R42151
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License Number State | NM
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