Provider Demographics
NPI:1487685053
Name:GARDEN, IRENE ANN (CNM)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:ANN
Last Name:GARDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-0148
Mailing Address - Fax:505-272-9991
Practice Address - Street 1:6900 GONZALES RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2401
Practice Address - Country:US
Practice Address - Phone:505-925-3508
Practice Address - Fax:505-272-4816
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17188163W00000X
NM415367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000S6049Medicaid
AZ774283Medicaid
TX8HBJ56Medicare ID - Type UnspecifiedHSZ001
NM000S6049Medicaid
P01697Medicare UPIN
AZ774283Medicaid