Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 13112R | NM |
NPI | 1073926887 |
---|---|
Provider Name | Diana Harris |
First Address | Rio Rancho, NM 87144-6711 |
Second Address | Rio Rancho, NM 87144-6711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 09/06/2014 |