Provider Demographics
NPI:1578042958
Name:ARCHULETA, REBECCA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:ARCHULETA
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:VELARDE
Mailing Address - State:NM
Mailing Address - Zip Code:87582-0145
Mailing Address - Country:US
Mailing Address - Phone:505-929-0650
Mailing Address - Fax:
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1226
Practice Address - Country:US
Practice Address - Phone:505-727-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM747176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife