Basic Information
Provider Information | |||||||||
NPI: | 1053504852 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VEIT | ||||||||
FirstName: | MARINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VEIT | ||||||||
OtherFirstName: | MARINA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 130 | ||||||||
Address2: |   | ||||||||
City: | SAN FIDEL | ||||||||
State: | NM | ||||||||
PostalCode: | 870490130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5055525385 | ||||||||
FaxNumber: | 5055525490 | ||||||||
Practice Location | |||||||||
Address1: | EXIT 102 OFF I-40 1/2 MI SOUTH | ||||||||
Address2: |   | ||||||||
City: | SAN FIDEL | ||||||||
State: | NM | ||||||||
PostalCode: | 870490130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5055525385 | ||||||||
FaxNumber: | 5055525490 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/24/2007 | ||||||||
LastUpdateDate: | 08/24/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | R23960 | NM | Y |   | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.