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General NPI Number Information
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NPI Number | 1285667600
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Entity Type | Individual
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Provider Name | EDITH A. IWAN NP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 NAVARRE BLVD.
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City | THOREAU
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State | NM
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Zip | 87323-1017
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Country | US
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Telephone | 505-862-7417
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Fax | 505-862-8300
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | THOREAU
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State | NM
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Zip | 87323-0028
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Country | US
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Telephone | 505-862-7417
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Fax | 505-862-8300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R31814
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License Number State | NM
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