Provider Demographics
NPI:1164684361
Name:ORTMANN, NIA NOBES (PHARMD)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:NOBES
Last Name:ORTMANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1828
Mailing Address - Country:US
Mailing Address - Phone:505-299-8600
Mailing Address - Fax:505-299-8609
Practice Address - Street 1:7425 CHAVENELLE RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9568
Practice Address - Country:US
Practice Address - Phone:563-588-8709
Practice Address - Fax:505-299-8609
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64683Medicaid