Healthcare Provider Details

I. General information

NPI: 1295734945
Provider Name (Legal Business Name): TERRY WAYNE HANCOCK MSN, RN,BC FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEEL AVE
SOCORRO NM
87801-4649
US

IV. Provider business mailing address

200 NEEL AVE
SOCORRO NM
87801-4649
US

V. Phone/Fax

Practice location:
  • Phone: 575-418-9563
  • Fax:
Mailing address:
  • Phone: 575-418-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: