Provider Demographics
NPI:1245292242
Name:RIFE, SYLVIA ANNE (FNP)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ANNE
Last Name:RIFE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:ANNE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9347
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-226-0099
Practice Address - Street 1:42121 US HWY 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9347
Practice Address - Country:US
Practice Address - Phone:575-356-6652
Practice Address - Fax:575-226-0099
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID15702A363LF0000X
NMCNP-01941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84328533Medicaid
NM84328533Medicaid