Provider Demographics
NPI:1083643860
Name:HAUENSTEIN, MERIBETH (APRN,CS)
Entity Type:Individual
Prefix:
First Name:MERIBETH
Middle Name:
Last Name:HAUENSTEIN
Suffix:
Gender:F
Credentials:APRN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S DON ROSER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4567
Mailing Address - Country:US
Mailing Address - Phone:575-521-4848
Mailing Address - Fax:575-522-1798
Practice Address - Street 1:1170 N SOLANO DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2371
Practice Address - Country:US
Practice Address - Phone:505-522-4977
Practice Address - Fax:505-528-5039
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR24758363LP0808X
NMCNS00081364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN4216Medicaid
NM344531405Medicare ID - Type Unspecified