Healthcare Provider Details

I. General information

NPI: 1790996833
Provider Name (Legal Business Name): RURAL HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 THORNHILL RD STE 2
LOVINGTON NM
88260-9566
US

IV. Provider business mailing address

399 THORNHILL RD STE 2
LOVINGTON NM
88260-9566
US

V. Phone/Fax

Practice location:
  • Phone: 505-396-3589
  • Fax:
Mailing address:
  • Phone: 505-396-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR44519
License Number StateNM

VIII. Authorized Official

Name: MS. CAROL LEE TAYLOR
Title or Position: NURSE PRACTITIONER
Credential: DNP
Phone: 505-396-3589