Provider Demographics
NPI:1578042958
Name:ARCHULETA, REBECCA ANN (CNM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:1010 SPRUCE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2724
Mailing Address - Country:US
Mailing Address - Phone:505-367-0340
Mailing Address - Fax:505-367-0326
Practice Address - Street 1:1010 SPRUCE ST FL 3
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2724
Practice Address - Country:US
Practice Address - Phone:505-367-0340
Practice Address - Fax:505-367-0326
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2024-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM747367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife