Provider Demographics
NPI:1134152721
Name:HEATH-WEST, ELIZABETH TERTIA (CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TERTIA
Last Name:HEATH-WEST
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:PO BOX 27829
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-232-1920
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:4705 MONTGOMERY NE
Practice Address - Street 2:SUITE 301-302
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-727-7600
Practice Address - Fax:505-727-7640
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM254176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93443Medicaid
NM93443Medicaid