Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 10073R | NM |
N | 176B00000X | Midwife | MW205 | FL |
NPI | 1154640258 |
---|---|
Provider Name | Ms. Maribel Lemus |
First Address | Guadalupita, NM 87722 |
Second Address | Guadalupita, NM 87722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 28/05/2010 |