Healthcare Provider Details

I. General information

NPI: 1972076115
Provider Name (Legal Business Name): NIKI RAE ALLISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 23RD ST
FARMINGTON NM
87401-9076
US

IV. Provider business mailing address

1400 E 23RD ST
FARMINGTON NM
87401-9076
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8609
  • Fax: 505-599-8664
Mailing address:
  • Phone: 505-599-8609
  • Fax: 505-599-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-84403
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: