Healthcare Provider Details

I. General information

NPI: 1811547409
Provider Name (Legal Business Name): HALLEY MARIE FRIEDEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY JUNCTION 57, RT9
CROWNPOINT NM
87313
US

IV. Provider business mailing address

P.O BOX 358 HWY JUNCTION 57, RT9 CROWNPOINT, NM 87313
CROWNPOINT NM
87313
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5291
  • Fax: 505-786-6435
Mailing address:
  • Phone: 505-786-5291
  • Fax: 505-786-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226005
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: