Healthcare Provider Details

I. General information

NPI: 1336911841
Provider Name (Legal Business Name): RYANNE ENYART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 30TH ST
FARMINGTON NM
87402-8805
US

IV. Provider business mailing address

524 SHIRLEY ST
BLOOMFIELD NM
87413-6552
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-9840
  • Fax:
Mailing address:
  • Phone: 505-436-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number422393
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: