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General NPI Number Information
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NPI Number | 1396122776
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Entity Type | Organization
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Legal Business Name | SACRED PASSAGE MIDWIFERY
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 245 TUNE DRIVE
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City | EL PRADO
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State | NM
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Zip | 87529-1092
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Country | US
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Telephone | 575-770-5253
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1092
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City | EL PRADO
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State | NM
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Zip | 87529-1092
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Country | US
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Telephone | 575-770-5253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE SCHOCHET
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Credential | LM, CPM
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Telephone | 575-770-5253
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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 | 96367R
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License Number State | NM
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