Healthcare Provider Details

I. General information

NPI: 1972661148
Provider Name (Legal Business Name): JEANNE M CORNS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 WYOMING BLVD NE PMG WYOMING
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-5300
  • Fax: 505-291-5303
Mailing address:
  • Phone: 505-923-5355
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberR45190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: