Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD2010-0172 | NM |
N | 207VG0400X | Gynecologist | 35121536 | OH |
N | 207VG0400X | Gynecologist | MD2010-0172 | NM |
N | 207VX0000X | Obstetrician | MD2010-0172 | NM |
NPI | 1508903881 |
---|---|
Provider Name | Brook L Mcfadden |
First Address | Albuquerque, NM 87109-4407 |
Second Address | Albuquerque, NM 87109-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29825334 | (05) | NM |