MEDICARE: RUTH ELAINE REGAN CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	261	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093736704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELAINE REGAN CNM

Provider Business Mailing Address
First Line	:	1900 HOT SPRINGS BLVD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3481
Country	:	US
Telephone Number	:	505-401-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 HOT SPRINGS BLVD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3481
Country	:	US
Telephone Number	:	505-401-4791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	05/15/2012

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