Healthcare Provider Details

I. General information

NPI: 1932261666
Provider Name (Legal Business Name): MELANIE A MAYO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE A RICE CNP

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 LOUISIANA BLVD. NE SUITE C
ALBUQUERQUE NM
87113-1761
US

IV. Provider business mailing address

8210 LOUISIANA BLVD. NE SUITE C
ALBUQUERQUE NM
87113-1761
US

V. Phone/Fax

Practice location:
  • Phone: 505-858-1222
  • Fax: 505-858-1224
Mailing address:
  • Phone: 505-858-1222
  • Fax: 505-858-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR28421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: