Healthcare Provider Details

I. General information

NPI: 1851849806
Provider Name (Legal Business Name): MARGARET BARBOUR VON HENDRICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 OLD HWY 66
EDGEWOOD NM
87015
US

IV. Provider business mailing address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-2396
  • Fax:
Mailing address:
  • Phone: 505-255-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: