Healthcare Provider Details

I. General information

NPI: 1508159906
Provider Name (Legal Business Name): CARLENE HURST RN, MSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MAIN ST STE 2
LAS CRUCES NM
88005-2917
US

IV. Provider business mailing address

1100 S MAIN ST STE 2
LAS CRUCES NM
88005-2917
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-5365
  • Fax: 575-524-1454
Mailing address:
  • Phone: 575-636-5365
  • Fax: 575-524-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN-71282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: