Healthcare Provider Details

I. General information

NPI: 1952814196
Provider Name (Legal Business Name): DEBRA G HANUS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12325 FORT MCRAE RD.
LAS CRUCES NM
88007
US

IV. Provider business mailing address

P.O. BOX 136
RADIUM SPRINGS NM
88054
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-8517
  • Fax:
Mailing address:
  • Phone: 575-527-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR47102
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: