Healthcare Provider Details

I. General information

NPI: 1740399831
Provider Name (Legal Business Name): NICHOLAS J ROWLEY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMMERCE WAY #104
CLOVIS NM
88101
US

IV. Provider business mailing address

201 COMMERCE WAY #104
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-3385
  • Fax: 575-762-3386
Mailing address:
  • Phone: 575-762-3385
  • Fax: 575-762-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number76-258
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number76-258
License Number StateNM

VIII. Authorized Official

Name: LYNETTA BABBIT
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-762-3385