Healthcare Provider Details

I. General information

NPI: 1871348656
Provider Name (Legal Business Name): ARYN AMETHYST TALAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1199
SHIPROCK NM
87420-1199
US

IV. Provider business mailing address

PO BOX 531
FRUITLAND NM
87416-0531
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-4984
  • Fax:
Mailing address:
  • Phone: 505-592-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2023-0620
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: