Healthcare Provider Details

I. General information

NPI: 1740571868
Provider Name (Legal Business Name): REBECCA B NYE DOM, MSTOM, DIPL.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3532 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

IV. Provider business mailing address

1701 RIDGECREST CIR SE
ALBUQUERQUE NM
87108-4459
US

V. Phone/Fax

Practice location:
  • Phone: 505-785-1760
  • Fax:
Mailing address:
  • Phone: 203-654-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM1274
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: