Healthcare Provider Details

I. General information

NPI: 1871748707
Provider Name (Legal Business Name): MS. DEVON ANN EHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ACADEMY RD NE APT #1235
ALBUQUERQUE NM
87111-7245
US

IV. Provider business mailing address

12200 ACADEMY RD NE APT #1235
ALBUQUERQUE NM
87111-7245
US

V. Phone/Fax

Practice location:
  • Phone: 908-531-0067
  • Fax:
Mailing address:
  • Phone: 908-531-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number331759
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: