Healthcare Provider Details

I. General information

NPI: 1902621360
Provider Name (Legal Business Name): CYRENE MAY IBANEZ BAGAYAS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 358
CROWNPOINT NM
87313-0358
US

IV. Provider business mailing address

1102 S TABOR AVE APT 602
NORTH PLATTE NE
69101-7765
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5291
  • Fax:
Mailing address:
  • Phone: 308-660-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number92761
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: