Healthcare Provider Details

I. General information

NPI: 1013215813
Provider Name (Legal Business Name): DEANNA S IOVINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH MUNDO
DULCE NM
87528
US

IV. Provider business mailing address

PO BOX 374
CHAMA NM
87520-0374
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-3291
  • Fax:
Mailing address:
  • Phone: 505-927-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-71434
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: