Provider Demographics
NPI:1225073117
Name:HAFER, BARBARA F NYLENE (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:F NYLENE
Last Name:HAFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W LEA ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5110
Mailing Address - Country:US
Mailing Address - Phone:575-391-0270
Mailing Address - Fax:575-391-0271
Practice Address - Street 1:200 W. LEA STREET
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:575-391-0270
Practice Address - Fax:575-391-0271
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR08654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00070533Medicaid
S22197Medicare UPIN
NM00070533Medicaid