Provider Demographics
NPI:1326368093
Name:WAUGH, MONA RAE (CNM)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:RAE
Last Name:WAUGH
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:385 CALLE DE ALEGRA BLDG C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3423
Practice Address - Country:US
Practice Address - Phone:575-556-8200
Practice Address - Fax:575-521-7199
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2018-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM600367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM600OtherNM DEPARTMENT OF HEALTH CERTIFIED NURSE-MIDWIFE
NMR44548OtherBOARD OF NURSING
NM26252805Medicaid
NMCS00215472OtherSTATE CONTROLLED SUBSTANCE NEW MEXICO