Healthcare Provider Details

I. General information

NPI: 1396336392
Provider Name (Legal Business Name): HIBA EL-YASSIN MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 US HIGHWAY 550 CUBA, NM 87103
CUBA NM
87103
US

IV. Provider business mailing address

821 MAXINE ST NE
ALBUQUERQUE NM
87123-1206
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-0550
  • Fax:
Mailing address:
  • Phone: 505-610-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10002780
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62690
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: