Healthcare Provider Details

I. General information

NPI: 1518284546
Provider Name (Legal Business Name): JANE MAE IVES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GOLD AVE SW # 548
ALBUQUERQUE NM
87102-3335
US

IV. Provider business mailing address

PO BOX 6835
ALBUQUERQUE NM
87197-6835
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax:
Mailing address:
  • Phone: 225-305-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number777942
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP07102
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP78297
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: