Healthcare Provider Details

I. General information

NPI: 1811591472
Provider Name (Legal Business Name): AMANDA ANN GIDEON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY
HOBBS NM
88240-9100
US

IV. Provider business mailing address

PO BOX 7135
HOBBS NM
88241-7135
US

V. Phone/Fax

Practice location:
  • Phone: 575-492-5000
  • Fax:
Mailing address:
  • Phone: 575-441-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number56441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: