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General NPI Number Information
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NPI Number | 1801866983
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Entity Type | Individual
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Provider Name | MARY M. FORLINES CNM
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1900 REDROCK DR REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
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City | GALLUP
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State | NM
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Zip | 87301-5682
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Country | US
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Telephone | 505-863-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 REDROCK DR PFS DEPT
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City | GALLUP
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State | NM
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Zip | 87301-5683
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Country | US
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Telephone | 505-863-7000
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Fax |
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 457
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License Number State | NM
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