Healthcare Provider Details

I. General information

NPI: 1477546463
Provider Name (Legal Business Name): HARUHAUANI SPRUCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 02/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S FOCH ST
T OR C NM
87901-3331
US

IV. Provider business mailing address

455 S FOCH ST
T OR C NM
87901-3331
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-4000
  • Fax: 404-601-2761
Mailing address:
  • Phone: 575-894-4000
  • Fax: 404-601-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002-0475
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: