Basic Information
| Provider Information | |||||||||
| NPI: | 1841842812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | REBYL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JAMES, GOWER | ||||||||
| OtherFirstName: | SHARON | ||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 719 SAN MATEO BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871081434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054850464 | ||||||||
| FaxNumber: | 5052661017 | ||||||||
| Practice Location | |||||||||
| Address1: | 3676 PARKER BLVD | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810082212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195532200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.1639169 | CO | N | Nursing Service Providers | Registered Nurse | 363L00000X | 0998198 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 0998198 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.