Healthcare Provider Details

I. General information

NPI: 1396520003
Provider Name (Legal Business Name): ADILENE NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-0943
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: