Provider Demographics
NPI:1164957304
Name:NANEZ, SANDRA JAE (MA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JAE
Last Name:NANEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JAE
Other - Last Name:DEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2551 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2551 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1213
Practice Address - Country:US
Practice Address - Phone:505-833-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health