Individual
MS. MELISSA Y WYACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
I-40 EXIT 102, SAN FIDEL, NM 87049-0130
(505) 552-5324
(505) 552-5811
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5324
(505) 552-5811
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R29030
NM
163WC1500X
Community Health Registered Nurse
Primary
R29030
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R29030
NURSING
NM
Enumeration date
08/20/2007
Last updated
08/20/2007
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