Healthcare Provider Details

I. General information

NPI: 1447282769
Provider Name (Legal Business Name): JUDITH L. BIXBY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

IV. Provider business mailing address

2607 CRESTVIEW DR
LAS CRUCES NM
88011-4507
US

V. Phone/Fax

Practice location:
  • Phone: 505-647-2800
  • Fax: 505-647-2898
Mailing address:
  • Phone: 505-522-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number35615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: