Healthcare Provider Details

I. General information

NPI: 1932103728
Provider Name (Legal Business Name): MELINDA A TOTH CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MELINDA A LAVER-TOTH CNS

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E COUNTRY CLUB RD
ROSWELL NM
88201-6520
US

IV. Provider business mailing address

PO BOX 8387
ALBUQUERQUE NM
87198-8387
US

V. Phone/Fax

Practice location:
  • Phone: 505-623-2836
  • Fax: 505-623-2841
Mailing address:
  • Phone: 505-843-2922
  • Fax: 505-843-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberR46751
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: