Healthcare Provider Details

I. General information

NPI: 1134126964
Provider Name (Legal Business Name): JANE N SEAVERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HMS COBRE HEALTH CLINIC 1107 TOM FOY BLVD.
BAYARD NM
88023
US

IV. Provider business mailing address

HMS COBRE HEALTH CLINIC 1107 TOM FOY BLVD, PO BOX 1389
BAYARD NM
88023
US

V. Phone/Fax

Practice location:
  • Phone: 505-537-5068
  • Fax: 505-537-5071
Mailing address:
  • Phone: 505-537-5068
  • Fax: 505-537-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR20035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: