Provider Demographics
NPI:1740571868
Name:NYE, REBECCA B (DOM, MSTOM, DIPLOM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:NYE
Suffix:
Gender:F
Credentials:DOM, MSTOM, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIDGECREST CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4459
Mailing Address - Country:US
Mailing Address - Phone:203-654-1808
Mailing Address - Fax:
Practice Address - Street 1:3532 ANDERSON AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1612
Practice Address - Country:US
Practice Address - Phone:505-785-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM1274171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist