Provider Demographics
NPI:1073744868
Name:TAFOYA, NADINE (LISW)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:
Last Name:TAFOYA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-1407
Mailing Address - Country:US
Mailing Address - Phone:505-753-9560
Mailing Address - Fax:505-753-9168
Practice Address - Street 1:1 KEE RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8907
Practice Address - Country:US
Practice Address - Phone:505-753-9560
Practice Address - Fax:505-753-9168
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor