MEDICARE: JANA WEISBORN PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-01594	NM

General Provider Information

NPI Number	:	1487975082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA WEISBORN PMHNP-BC

Provider Business Mailing Address
First Line	:	7850 JEFFERSON ST NE STE 300
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4314
Country	:	US
Telephone Number	:	505-884-1114
Fax Number	:	505-884-3004

Provider Business Practice Location Address
First Line	:	7850 JEFFERSON ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4315
Country	:	US
Telephone Number	:	505-884-1114
Fax Number	:	505-884-3004

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/12/2026

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