MEDICARE: CHANGING WOMAN INITIATIVE

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

General Provider Information

NPI Number	:	1972087054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING WOMAN INITIATIVE

Provider Business Mailing Address
First Line	:	4133 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6741
Country	:	US
Telephone Number	:	505-660-6372
Fax Number	:	505-393-5165

Provider Business Practice Location Address
First Line	:	4133 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6741
Country	:	US
Telephone Number	:	505-660-6372
Fax Number	:	505-393-5165

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/FOUNDER
Name	:	NICOLLE GONZALES
Credential	:	CNM
Telephone Number	:	505-954-1546

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	12/20/2022

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Directions to “CHANGING WOMAN INITIATIVE ” Practice Location

Language	Start Address	Practice Location

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