Tanya Johnson
Individual provider Active NPI Social Worker · Mora, NM
NPI 1760891782 · NPPES record last updated Aug 4, 2014
Key facts
- NPI
- 1760891782
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- M-08343 (NM)
- Practice address
- 3 Mora Valley Clinic Rd
Mora, NM 87732-2202 - Phone
- (575) 387-2201
- Fax
- (575) 387-9149
- NPI assigned
- Aug 4, 2014
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| M-08343 | NM | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M-08343 | NM | Yes |
Addresses
Primary practice location
3 Mora Valley Clinic Rd
Mora, NM 87732-2202
Mailing address
3 Mora Valley Clinic Rd
Mora, NM 87732-2202
Phone (575) 387-2201
Other providers in Mora, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2014. 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.