Healthcare Provider Details

I. General information

NPI: 1245208677
Provider Name (Legal Business Name): NANCY RHIEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BLDG D-102
FARMINGTON NM
87401-8991
US

IV. Provider business mailing address

5711 RINCONADA ST
FARMINGTON NM
87402-4976
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4429
  • Fax: 505-327-4420
Mailing address:
  • Phone: 505-320-7764
  • Fax: 505-327-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0002793
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2001-PA10
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: