Provider Demographics
NPI:1952846156
Name:FAIN, EVA DENNIE (RN CDE)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:DENNIE
Last Name:FAIN
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11316 BISCAYNE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2612
Mailing Address - Country:US
Mailing Address - Phone:303-704-1874
Mailing Address - Fax:
Practice Address - Street 1:11316 BISCAYNE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2612
Practice Address - Country:US
Practice Address - Phone:303-704-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR32762163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator