1962530121 NPI number — DR. NANCY N SALLEE PH.D

Table of content: DR. NANCY N SALLEE PH.D (NPI 1962530121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962530121 NPI number — DR. NANCY N SALLEE PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALLEE
Provider First Name:
NANCY
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962530121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1395 MISSOURI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88001-5327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-522-5466
Provider Business Mailing Address Fax Number:
575-521-8611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 MISSOURI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-522-5466
Provider Business Practice Location Address Fax Number:
575-521-8611
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  521 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1962530121 . This is a "NATIONAL PROVIDER IDENTIFIER NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 601013663 . This is a "PRESBYTERIAN/MAGELLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 920579500 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 434659 . This is a "PTAN (MEDICARE NOVITAS)" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 13507182 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220147 . This is a "EDUCATIONAL PSYCHOLOGIST IIIA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000N8486 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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