Nancy Ashworth, LPN

Individual provider Active NPI Licensed Practical Nurse · Bloomfield, NM

NPI 1689882367 · NPPES record last updated Jul 9, 2007

Key facts

NPI
1689882367
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
L05799 (NM)
Practice address
310 W Sycamore Ave
Bloomfield, NM 87413-5844
Phone
(505) 634-3673
Fax
(505) 634-3675
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
L05799NMMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X L05799 NM Yes

Addresses

Primary practice location

310 W Sycamore Ave
Bloomfield, NM 87413-5844

Mailing address

2619 N Mossman Dr
Farmington, NM 87401-9401
Phone (505) 634-3673

Other identifiers

IdentifierTypeStateIssuer
64434826MedicaidNM

Other providers in Bloomfield, NM

All providers in Bloomfield, NM · Licensed Practical Nurse in New Mexico

Sources for this page

Verify at the official NPI Registry.