Provider Demographics
NPI:1770682569
Name:NORRIS, JOAN DARBY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:DARBY
Last Name:NORRIS
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 1:1331 MAESTAS RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6268
Mailing Address - Country:US
Mailing Address - Phone:505-758-1215
Mailing Address - Fax:505-758-2683
Practice Address - Street 1:1331 MAESTAS RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6268
Practice Address - Country:US
Practice Address - Phone:505-758-1215
Practice Address - Fax:505-758-2683
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95297R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65359OtherPRESBYTERIAN
NM12083772OtherCAQH
NMQ2406Medicaid
NMNM00H609OtherBLUE CROSS BLUE SHIELD
NMPROVPI5297OtherMOLINA