Healthcare Provider Details

I. General information

NPI: 1679908560
Provider Name (Legal Business Name): EMILY P WEESE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY P KENNEDY RN

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
CLAYTON NM
88415-3304
US

IV. Provider business mailing address

300 WILSON ST
CLAYTON NM
88415-3304
US

V. Phone/Fax

Practice location:
  • Phone: 575-374-2585
  • Fax: 575-374-8146
Mailing address:
  • Phone: 575-374-2585
  • Fax: 575-374-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number76911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: