Provider Demographics
NPI:1134126964
Name:SEAVERS, JANE N (CNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:N
Last Name:SEAVERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HMS COBRE HEALTH CLINIC
Mailing Address - Street 2:1107 TOM FOY BLVD, PO BOX 1389
Mailing Address - City:BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88023
Mailing Address - Country:US
Mailing Address - Phone:505-537-5068
Mailing Address - Fax:505-537-5071
Practice Address - Street 1:HMS COBRE HEALTH CLINIC
Practice Address - Street 2:1107 TOM FOY BLVD.
Practice Address - City:BAYARD
Practice Address - State:NM
Practice Address - Zip Code:88023
Practice Address - Country:US
Practice Address - Phone:505-537-5068
Practice Address - Fax:505-537-5071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR20035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK4581Medicaid
NMK4581Medicaid