Provider Demographics
NPI:1447416045
Name:JOE, NEDRA ANN (RHIT,CCS,CNA)
Entity Type:Individual
Prefix:MS
First Name:NEDRA
Middle Name:ANN
Last Name:JOE
Suffix:
Gender:F
Credentials:RHIT,CCS,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ROAD 1490
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:NM
Mailing Address - Zip Code:87418-9603
Mailing Address - Country:US
Mailing Address - Phone:505-330-4497
Mailing Address - Fax:505-212-0646
Practice Address - Street 1:39 ROAD 1490
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:NM
Practice Address - Zip Code:87418-9603
Practice Address - Country:US
Practice Address - Phone:505-330-4497
Practice Address - Fax:505-212-0646
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM0060650708E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide