Provider Demographics
NPI:1336299460
Name:SCHIESS, NANCY M (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:SCHIESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:SCHIESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1350 JACKIE ST. SE, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-238-2997
Mailing Address - Fax:505-544-4631
Practice Address - Street 1:1350 JACKIE ST. SE, SUITE 104
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-238-2997
Practice Address - Fax:505-544-4631
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-957-922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA95792Medicaid
NMH1432Medicaid