Healthcare Provider Details

I. General information

NPI: 1285710327
Provider Name (Legal Business Name): CAROL ANNE CHASE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 COUNTY RD 13
CUBA NM
87013-0070
US

IV. Provider business mailing address

PO BOX 125
CUBA NM
87013-0125
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-3211
  • Fax:
Mailing address:
  • Phone: 505-289-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR43883
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: