Provider Demographics
NPI:1790712248
Name:ENOCH, JENNIFER HALI (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HALI
Last Name:ENOCH
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 1:1124 MONROE ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4518
Mailing Address - Country:US
Mailing Address - Phone:505-266-3416
Mailing Address - Fax:
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:505-272-4816
Practice Address - Fax:505-272-3815
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00163322367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200326156Medicaid