Provider Demographics
NPI:1225331192
Name:HAGGARD, MYRIAH (LM)
Entity Type:Individual
Prefix:
First Name:MYRIAH
Middle Name:
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2415
Mailing Address - Country:US
Mailing Address - Phone:505-795-9508
Mailing Address - Fax:
Practice Address - Street 1:941 DUNLAP ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2415
Practice Address - Country:US
Practice Address - Phone:505-795-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10075R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife