Healthcare Provider Details

I. General information

NPI: 1033212535
Provider Name (Legal Business Name): KAROLYN JEAN SCHAEFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 MAIN STREET
CUBA NM
87013
US

IV. Provider business mailing address

PO BOX 121 18 CAMINO GURULE
LA JARA NM
87027-0121
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-3291
  • Fax: 505-289-3648
Mailing address:
  • Phone: 505-289-0096
  • Fax: 505-289-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR36351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: