Provider Demographics
NPI:1528318805
Name:WEBB, AMY BETH (RN, CDE)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:WEBB
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 1:7037 VUELTA VISTOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4605
Mailing Address - Country:US
Mailing Address - Phone:575-758-4224
Mailing Address - Fax:575-751-5212
Practice Address - Street 1:1090 GOAT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-4224
Practice Address - Fax:575-751-5212
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525718163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator