Healthcare Provider Details

I. General information

NPI: 1679318166
Provider Name (Legal Business Name): NATASHA MACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

V. Phone/Fax

Practice location:
  • Phone: 575-597-2568
  • Fax: 575-313-8236
Mailing address:
  • Phone: 575-597-2568
  • Fax: 575-313-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1584
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: