MEDICARE: JANE N SEAVERS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R20035	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE N SEAVERS CNP

Provider Business Mailing Address
First Line	:	HMS COBRE HEALTH CLINIC
Second Line	:	1107 TOM FOY BLVD, PO BOX 1389
City	:	BAYARD
State	:	NM
Zip	:	88023
Country	:	US
Telephone Number	:	505-537-5068
Fax Number	:	505-537-5071

Provider Business Practice Location Address
First Line	:	HMS COBRE HEALTH CLINIC
Second Line	:	1107 TOM FOY BLVD.
City	:	BAYARD
State	:	NM
Zip	:	88023
Country	:	US
Telephone Number	:	505-537-5068
Fax Number	:	505-537-5071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2007

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