Provider Demographics
NPI:1598328478
Name:BRUNACINI, RACHEL (LM, CPM)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BRUNACINI
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-3224
Mailing Address - Country:US
Mailing Address - Phone:505-415-0403
Mailing Address - Fax:
Practice Address - Street 1:2510 RIO GRANDE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-3224
Practice Address - Country:US
Practice Address - Phone:505-415-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM19189R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19189ROtherMIDWIFERY LICENSE