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General NPI Number Information
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NPI Number | 1548447543
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Entity Type | Organization
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Legal Business Name | COMMUNITY MIDWIVES LLC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 603 NE AZTEC BLVD
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City | AZTEC
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State | NM
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Zip | 87410-1706
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Country | US
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Telephone | 970-385-2626
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Fax | 970-375-9053
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Provider Business Mailing Address
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Address Line | 755 E 2ND AVE
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City | DURANGO
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State | CO
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Zip | 81301-5498
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Country | US
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Telephone | 970-385-2626
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Fax | 970-375-9053
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | MS. JUANITA NELSON
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Credential | LM, RM, CPM
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Telephone | 970-385-2626
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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 | 84100-R
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License Number State | NM
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