Provider Demographics
NPI:1174134423
Name:HUGHES, JESSIE MARIE (LM)
Entity type:Individual
Prefix:PROF
First Name:JESSIE
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-1194
Mailing Address - Country:US
Mailing Address - Phone:505-423-5703
Mailing Address - Fax:
Practice Address - Street 1:29 PABLITA RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-8714
Practice Address - Country:US
Practice Address - Phone:505-423-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife