Healthcare Provider Details

I. General information

NPI: 1073961355
Provider Name (Legal Business Name): RHAYNA DANNIELLE WALIZER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PINSBARRI DR
ACOMA NM
87034
US

IV. Provider business mailing address

45 PINSBARRI DR
ACOMA NM
87034
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5166
  • Fax:
Mailing address:
  • Phone: 505-552-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX09509
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: