Healthcare Provider Details

I. General information

NPI: 1376702803
Provider Name (Legal Business Name): PATRICIA E. WAHE III LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W. GRIGGS
LAS CRUCES NM
88001
US

IV. Provider business mailing address

1320 S. SOLANO
LAS CRUCES NM
88005
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-2896
  • Fax: 575-647-2898
Mailing address:
  • Phone: 575-527-7900
  • Fax: 575-571-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM2507
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: