Healthcare Provider Details

I. General information

NPI: 1962510743
Provider Name (Legal Business Name): SHIMER S CARDEN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 AVENUE E CARRIZOZO HEALTH CENTER
CARRIZOZO NM
88301
US

IV. Provider business mailing address

121 EL PASO RD
RUIDOSO NM
88345-6033
US

V. Phone/Fax

Practice location:
  • Phone: 505-648-2317
  • Fax: 505-648-4113
Mailing address:
  • Phone: 575-630-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS00062
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR21328
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: