Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 433 | NM |
N | 207VX0000X | Obstetrician | R42438 | NM |
NPI | 1154439354 |
---|---|
Provider Name | Elizabeth A. Withnall |
First Address | Las Vegas, NM 87701-4425 |
Second Address | Las Vegas, NM 87701-4425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 15/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
94060 | (05) | NM |
Q60313 | (02) | |
Q60313 | (02) | NM |