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NPI Code Detail

MEDICARE: JOSHUA BANCROFT

MEDICARE: JOSHUA BANCROFT
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1821339987
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA BANCROFT
Provider Business Mailing Address
First Line : PO BOX 28220
Second Line :
City : SANTA FE
State : NM
Zip : 87592-8220
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 608 REILLY AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-2634
Country : US
Telephone Number : 505-670-9243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2013
Last Update Date : 03/13/2013

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Directions to “ JOSHUA BANCROFT ” Practice Location

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