Healthcare Provider Details

I. General information

NPI: 1922553460
Provider Name (Legal Business Name): FRANCIS IAN C BICOL DNP, CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N KENTUCKY AVE
ROSWELL NM
88201-4721
US

IV. Provider business mailing address

500 N KENTUCKY AVE
ROSWELL NM
88201-4721
US

V. Phone/Fax

Practice location:
  • Phone: 575-363-8178
  • Fax:
Mailing address:
  • Phone: 575-363-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01448
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: