Individual
NICOLE MAILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M., CPM
Contact information
Practice address
5540 NDCBU, TAOS, NM 87571-6122
(575) 751-4690
(575) 751-4690
Mailing address
5540 NDCBU, TAOS, NM 87571-6122
(575) 751-4690
(575) 751-4690
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
09060R
NM
Other
Enumeration date
12/04/2009
Last updated
12/04/2009
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