Healthcare Provider Details

I. General information

NPI: 1649427451
Provider Name (Legal Business Name): YVONNE MICHELLE MOUCHETTE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MISSOURI AVE SUITE 7
LAS CRUCES NM
88011-5075
US

IV. Provider business mailing address

2801 MISSOURI AVE SUITE 7
LAS CRUCES NM
88011-5075
US

V. Phone/Fax

Practice location:
  • Phone: 575-373-8415
  • Fax: 575-373-8416
Mailing address:
  • Phone: 575-373-8415
  • Fax: 575-373-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR44376
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberR44376
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: