Individual
PHYLLIS DIANE MOREHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
500 NORTH MUNDO, DULCE, NM 87528-0187
(575) 759-3291
Mailing address
P O BOX 187, DULCE, NM 87528-0187
(575) 759-7237
(575) 759-7294
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1091032
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
01/13/2012
Last updated
02/02/2012
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