Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 519 | NM |
NPI | 1003849662 |
---|---|
Provider Name | Wendy Kimmelman |
First Address | Albuquerque, NM 87120-1710 |
Second Address | Albuquerque, NM 87106-5205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 26/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28982339 | (05) | NM |
Q31578 | (02) |