Provider Demographics
NPI:1417237942
Name:TAOS HOMEBIRTH & MIDWIFERY LLC
Entity Type:Organization
Organization Name:TAOS HOMEBIRTH & MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE LM, CPM
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:575-751-4690
Mailing Address - Street 1:5540 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6122
Mailing Address - Country:US
Mailing Address - Phone:575-770-1470
Mailing Address - Fax:575-751-4690
Practice Address - Street 1:5540 NDCBU
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6122
Practice Address - Country:US
Practice Address - Phone:575-770-1470
Practice Address - Fax:575-751-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM09064R176B00000X
NM09060R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty