Healthcare Provider Details

I. General information

NPI: 1508100207
Provider Name (Legal Business Name): JANA JOEL MCBURNEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

1401 10TH ST STE 1
ALAMOGORDO NM
88310-5012
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-3041
  • Fax: 575-572-2259
Mailing address:
  • Phone: 575-434-5195
  • Fax: 575-434-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03520
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: