Edgar Allan Bautista, RN
Individual provider Active NPI Emergency Registered Nurse · Shiprock, NM
NPI 1760230809 · NPPES record last updated May 13, 2024
Key facts
- NPI
- 1760230809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Registered Nurse 163WE0003X
- License
- 95330098 (CA)
- Practice address
- PO Box 160
Shiprock, NM 87420-0160 - Phone
- (505) 368-6001
- NPI assigned
- May 13, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95330098 | CA | MD | Emergency Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 95330098 | CA | Yes |
Addresses
Primary practice location
PO Box 160
Shiprock, NM 87420-0160
Mailing address
3116 N Cochiti Ave
Farmington, NM 87401-2050
Phone (949) 620-7280
Other providers in Shiprock, NM
- Michael C Barish
- Denise Suzanne Bartley
- Rosalynn Barton
- Joseph Baumgart
- Vaishali E. Bauskar
- Amber Rochelle Beardslee
- Dan Y Begay
- Ernest Harry Begay
- Tanisha Kayla Begay
- Tommie T Begay
All providers in Shiprock, NM · Emergency Registered Nurse in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.