Provider Demographics
NPI:1891852240
Name:CENTER FOR PRENATAL DEVELOPMENT
Entity Type:Organization
Organization Name:CENTER FOR PRENATAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-883-5657
Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:STE. 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-883-5657
Mailing Address - Fax:505-883-5322
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:STE. 106
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-883-5657
Practice Address - Fax:505-883-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-270207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96-270OtherLICENSE
F86756Medicare UPIN