Healthcare Provider Details

I. General information

NPI: 1467996728
Provider Name (Legal Business Name): SYLVIA BEEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S HALAGUENO ST STE 4
CARLSBAD NM
88220-5748
US

IV. Provider business mailing address

110 S HALAGUENO ST STE 4
CARLSBAD NM
88220-5748
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-0063
  • Fax: 575-885-0065
Mailing address:
  • Phone: 575-885-0063
  • Fax: 575-885-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGP-01596
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: