MEDICARE: WERNER HENRY BECKERHOFF JR. CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R25684	NM

General Provider Information

NPI Number	:	1457354359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WERNER HENRY BECKERHOFF JR. CRNA

Provider Business Mailing Address
First Line	:	5410 COLIBRI PL
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-0983
Country	:	US
Telephone Number	:	505-564-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 COLIBRI PL
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-0983
Country	:	US
Telephone Number	:	505-564-3402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/25/2008

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