Healthcare Provider Details

I. General information

NPI: 1639147937
Provider Name (Legal Business Name): APRIL RACQUEL NABAHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 491 NORTH
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6627
  • Fax: 505-368-6688
Mailing address:
  • Phone: 505-368-6627
  • Fax: 505-368-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8884
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: