Provider Demographics
NPI:1407660889
Name:NEZ, MARIAN (CHW)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:NEZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MEDICINE HORSE DR
Mailing Address - Street 2:PO BOX 3338
Mailing Address - City:TOHAJIILEE
Mailing Address - State:NM
Mailing Address - Zip Code:87026
Mailing Address - Country:US
Mailing Address - Phone:505-908-2307
Mailing Address - Fax:505-908-2306
Practice Address - Street 1:129 MEDICINE HORSE DR
Practice Address - Street 2:
Practice Address - City:TOHAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:505-908-2306
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMS1-026172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker