Healthcare Provider Details

I. General information

NPI: 1205012895
Provider Name (Legal Business Name): ELIZABETH R ALDEN RN,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MANZANO RD
CORRALES NM
87048-8385
US

IV. Provider business mailing address

10 MANZANO RD
CORRALES NM
87048-8385
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-2134
  • Fax: 505-856-5530
Mailing address:
  • Phone: 505-828-2134
  • Fax: 505-856-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberR21244
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: