Healthcare Provider Details

I. General information

NPI: 1447416045
Provider Name (Legal Business Name): NEDRA ANN JOE RHIT,CCS,CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 ROAD 1490
LA PLATA NM
87418-9603
US

IV. Provider business mailing address

39 ROAD 1490
LA PLATA NM
87418-9603
US

V. Phone/Fax

Practice location:
  • Phone: 505-330-4497
  • Fax: 505-212-0646
Mailing address:
  • Phone: 505-330-4497
  • Fax: 505-212-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNM0060650708E
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: