MEDICARE: NURTURE NEW MEXICO, LLC

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	174N00000X	Lactation Consultant (Non-RN)
2	374J00000X	Doula

General Provider Information

NPI Number	:	1851105498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURTURE NEW MEXICO, LLC

Provider Business Mailing Address
First Line	:	1025 RIVERSTONE RD TRLR 8
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2881
Country	:	US
Telephone Number	:	505-716-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 RIVERSTONE RD TRLR 8
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2881
Country	:	US
Telephone Number	:	505-716-2227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY PERRY
Credential	:	CD
Telephone Number	:	505-716-2227

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	08/22/2025

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