Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 474 | NM |
NPI | 1083708473 |
---|---|
Provider Name | Gail L Rothfork |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87108-2921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 04/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6180345 | (05) | NM |
P51931 | (02) |