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Individual

LOUISE SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LM, CPM

Contact information

Practice address
4916 4TH ST NW, ALBUQUERQUE, NM 87107-3949
(505) 450-2222
(877) 500-7949
Mailing address
4916 4TH ST NW, ALBUQUERQUE, NM 87107-3949
(505) 450-2222
(877) 500-7949

Taxonomy

Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
1412R
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
54937582
NM
Enumeration date
04/02/2014
Last updated
01/24/2017
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