MEDICARE: LORIELLA HADEN RN

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	R38100	NM

General Provider Information

NPI Number	:	1518838275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIELLA HADEN RN

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	PORTALES
State	:	NM
Zip	:	88130-0847
Country	:	US
Telephone Number	:	575-562-4458
Fax Number	:	575-562-4460

Provider Business Practice Location Address
First Line	:	PO BOX 5
Second Line	:
City	:	SAN JON
State	:	NM
Zip	:	88434-0005
Country	:	US
Telephone Number	:	575-576-2466
Fax Number	:	575-576-2523

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

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/16/2025

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Directions to “ LORIELLA HADEN RN” Practice Location

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