Healthcare Provider Details

I. General information

NPI: 1316486723
Provider Name (Legal Business Name): PAMELA ARTERBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HIGH STREET
RED RIVER NM
87558
US

IV. Provider business mailing address

PO BOX 742
RED RIVER NM
87558
US

V. Phone/Fax

Practice location:
  • Phone: 575-754-6117
  • Fax: 575-754-3258
Mailing address:
  • Phone: 575-754-6117
  • Fax: 575-754-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR15737
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: