Provider Demographics
NPI:1871847046
Name:NATURAL BIRTH MIDWIFERY
Entity Type:Organization
Organization Name:NATURAL BIRTH MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHEWA
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM, MPH
Authorized Official - Phone:505-266-5762
Mailing Address - Street 1:123 WELLESLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1443
Mailing Address - Country:US
Mailing Address - Phone:505-266-5762
Mailing Address - Fax:505-268-7500
Practice Address - Street 1:123 WELLESLEY DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1443
Practice Address - Country:US
Practice Address - Phone:505-266-5762
Practice Address - Fax:505-268-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM04008R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97423882Medicaid