Healthcare Provider Details

I. General information

NPI: 1083643860
Provider Name (Legal Business Name): MERIBETH HAUENSTEIN APRN,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N SOLANO DR SUITE A
LAS CRUCES NM
88001-2371
US

IV. Provider business mailing address

1401 S DON ROSER DR SUITE A
LAS CRUCES NM
88011-4567
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-4977
  • Fax: 505-528-5039
Mailing address:
  • Phone: 575-521-4848
  • Fax: 575-522-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR24758
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS00081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: