=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891852240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR PRENATAL DEVELOPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 HOSPITAL LOOP NE STE. 106
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-883-5657
-----------------------------------------------------
Fax | 505-883-5322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 HOSPITAL LOOP NE STE. 106
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-883-5657
-----------------------------------------------------
Fax | 505-883-5322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEPHANIE HEDSTROM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 505-883-5657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VM0101X
-----------------------------------------------------
Taxonomy Name | Maternal & Fetal Medicine Physician
-----------------------------------------------------
License Number | 96-270
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------