Basic Information
| Provider Information | |||||||||
| NPI: | 1568473213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 S. SOLANO | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755277900 | ||||||||
| FaxNumber: | 5755714872 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 E. 10TH ST. | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754377404 | ||||||||
| FaxNumber: | 5754392861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | R32320 | NM | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 18677037 | 05 | NM | MEDICAID |