Provider Demographics
NPI:1396822128
Name:RAPHAELSON, SHERI ANNE (LM)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:ANNE
Last Name:RAPHAELSON
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0248
Mailing Address - Country:US
Mailing Address - Phone:505-747-3831
Mailing Address - Fax:505-753-3468
Practice Address - Street 1:410 PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3521
Practice Address - Country:US
Practice Address - Phone:505-747-3831
Practice Address - Fax:505-753-3468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92229R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96625Medicaid