Provider Demographics
NPI:1972575793
Name:DUPRE, STARLA D (CNM)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:D
Last Name:DUPRE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STARLA
Other - Middle Name:D
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:10511 GOLF COURSE RD NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5916
Mailing Address - Country:US
Mailing Address - Phone:505-727-4500
Mailing Address - Fax:505-727-4505
Practice Address - Street 1:10511 GOLF COURSE RD NW
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5916
Practice Address - Country:US
Practice Address - Phone:505-727-4500
Practice Address - Fax:505-727-4505
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR34083367A00000X
NMCNM417367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000S6026Medicaid
NM000S6026Medicaid
NM346376YR41Medicare PIN
NMS6026Medicaid
NM10002360OtherLOVELACE HEALTH/SALUD
420000747OtherRAILROAD MEDICARE
NM346376YR41Medicare PIN
NM201018787OtherPRESBYTERIAN HEALTH/SALUD
85031326887301A121OtherCHAMPUS
S73174Medicare UPIN