Healthcare Provider Details

I. General information

NPI: 1477787208
Provider Name (Legal Business Name): JERRIED LEE NOSEFF CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 N FOWLER ST
HOBBS NM
88240-2312
US

IV. Provider business mailing address

2410 N FOWLER ST
HOBBS NM
88240-2312
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-2040
  • Fax:
Mailing address:
  • Phone: 575-392-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: