Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 784 | NM |
NPI | 1114552114 |
---|---|
Provider Name | Amy Macleod |
First Address | Albuquerque, NM 87109-1234 |
Second Address | Albuquerque, NM 87109-1234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |