Provider Demographics
NPI:1528559739
Name:BEGAY, DEIDRE PRISCILLA
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:PRISCILLA
Last Name:BEGAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:PRISCILLA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3708 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4766
Mailing Address - Country:US
Mailing Address - Phone:505-860-8790
Mailing Address - Fax:
Practice Address - Street 1:MSCO9 5030 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program