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Individual

MARY M. FORLINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
1900 REDROCK DR, REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, GALLUP, NM 87301-5682
(505) 863-7200
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000

Taxonomy

Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
457
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10002995
LOVELACE HEALTH/SALUD
05
560377
AZ
01
850313268020
CHAMPUS
05
A7256
NM
01
NM006605
BC/BS
NM
01
PROVP12986
MOLINA
Enumeration date
01/23/2006
Last updated
07/08/2007
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