Provider Demographics
NPI:1245208677
Name:RHIEN, NANCY (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RHIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 TARRY TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-1100
Mailing Address - Country:US
Mailing Address - Phone:505-320-7764
Mailing Address - Fax:970-382-0122
Practice Address - Street 1:1 MERCADO ST STE 105
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7311
Practice Address - Country:US
Practice Address - Phone:970-382-8800
Practice Address - Fax:970-382-0122
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-PA10363A00000X
COPA.0002793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000141593Medicaid
NMQ16122Medicare UPIN