Provider Demographics
NPI:1134448939
Name:KAECK, DOROTHY REEVES (LM, CPM)
Entity type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:REEVES
Last Name:KAECK
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 1:49 CAMINO SUR DEL LLANO QUEMADO
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-9789
Mailing Address - Country:US
Mailing Address - Phone:575-770-9433
Mailing Address - Fax:
Practice Address - Street 1:49 CAMINO SUR DEL LLANO QUEMADO
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-9789
Practice Address - Country:US
Practice Address - Phone:575-770-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10030033176B00000X
NM13115R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife