Provider Demographics
NPI:1144748823
Name:BURGEON BIRTH-N-LIFE
Entity Type:Organization
Organization Name:BURGEON BIRTH-N-LIFE
Other - Org Name:BURGEON MIDWIFERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUIGLEY-TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:LM,IBCLC
Authorized Official - Phone:505-459-1901
Mailing Address - Street 1:901 MARQUETTE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1935
Mailing Address - Country:US
Mailing Address - Phone:505-459-1901
Mailing Address - Fax:866-730-6883
Practice Address - Street 1:901 MARQUETTE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1935
Practice Address - Country:US
Practice Address - Phone:505-459-1901
Practice Address - Fax:866-730-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15136R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty