Healthcare Provider Details

I. General information

NPI: 1972488617
Provider Name (Legal Business Name): ROBERT JOSEPH PAYETTE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAGEBRUSH ST SW
ALBUQUERQUE NM
87105-3942
US

IV. Provider business mailing address

1 SAGEBRUSH ST SW
ALBUQUERQUE NM
87105-3942
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-5474
  • Fax: 505-869-5474
Mailing address:
  • Phone: 505-869-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR58651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: