Healthcare Provider Details

I. General information

NPI: 1992514475
Provider Name (Legal Business Name): TYLER AARON NAFUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 WILDER LOOP NE
RIO RANCHO NM
87144-1441
US

IV. Provider business mailing address

2749 WILDER LOOP NE
RIO RANCHO NM
87144-1441
US

V. Phone/Fax

Practice location:
  • Phone: 505-604-5838
  • Fax:
Mailing address:
  • Phone: 505-604-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number67178
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: