Mamie Denetclaw, RN, CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

R26082 Issued in NM

Practice address

US Hwy 491 North
Shiprock, NM 87420

Phone

(505) 368-6401

Fax

(505) 368-6431

NPI assigned

Aug 24, 2007

Last updated

Aug 24, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187913600000",
    "number": "1679766463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6401",
            "fax_number": "505-368-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-6401",
            "fax_number": "505-368-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENETCLAW",
        "first_name": "MAMIE",
        "credential": "RN, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-24",
        "last_updated": "2007-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "NM",
            "license": "R26082",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NM",
            "license": "R26082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Davis, PHARMD
• Nathalie L. De Leon, RN
• Jarom Michael Decker, DDS
• Chandima Bandara Deegala, PHARMD
• Brian David Demby, MD
• Verdaleen Denetdale, LD/RD
• DHHS PHS Naihs Shiprock Hospital (Northern Navajo Medical Center - Pharmacy)
• DHHS PHS Naihs Shiprock Hospital (Northern Navajo Medical Center)
• DHHS PHS Naihs Shiprock Hospital (Northern Navajo Medical Center)
• DHHS, PHS, Naihs, Shiprock Hospital (Northern Navajo Medical Center)

• Diabetes Educator Registered Nurse in Shiprock, NM
• Providers in Shiprock, NM by specialty
• Diabetes Educator Registered Nurse in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.