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General NPI Number Information
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NPI Number | 1477826287
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Entity Type | Organization
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Legal Business Name | INDIGO MIDWIFERY
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 12036 COPPER AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1474
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Country | US
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Telephone | 505-604-9458
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Fax | 505-271-2979
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Provider Business Mailing Address
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Address Line | 12036 COPPER AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1474
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Country | US
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Telephone | 505-604-9458
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Fax | 505-271-2979
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Authorized Official
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Title or Position | MIDWIFE
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Name | JESSICA WEED
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Credential | LM, CPM, CD(DONA)
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Telephone | 505-604-9458
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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 | 10079R
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License Number State | NM
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