Healthcare Provider Details

I. General information

NPI: 1659641777
Provider Name (Legal Business Name): DIABETES SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
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 Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNM

VIII. Authorized Official

Name: CARLENE H. HURST
Title or Position: DIABETES EDUCATOR/OWNER
Credential: RN, CDE
Phone: 575-636-5365