Liesveld, Judy

Liesveld, Judy is an individual health care provider with primary practice located at 2111 College Dr Rehoboth Mckinley Christian Health Care Services, Gallup NM 87301-5600. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Liesveld, Judy can be contacted via phone (505) 863-1820.

Contact Information

Primary practice address
2111 College Dr Rehoboth Mckinley Christian Health Care Services Gallup NM 87301-5600
Phone: (505) 863-1820
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R30234 New Mexico

Profile Details

NPI number 1295707651
LBN Legal business name Liesveld, Judy
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1295707651 NPPES
New Mexico MEDICAID 99628
New Mexico Other PROVP14473
New Mexico Other 10002112
New Mexico Other 85031326887301A120
New Mexico MEDICAID 469066
New Mexico Other NM006180

Popular Providers