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Provider Information for 1972645497

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1972645497

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1972645497
Enumeration Date 2007-02-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3124 INDIANA ST NE
ALBUQUERQUE, NM 87110-2629
United States

Phone: 505-872-1917 | Fax:
View Map External Link
Primary Practice Address 1111 STANFORD DR NE
ALBUQUERQUE, NM 87106-3721
United States

Phone: 505-841-4100 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LW0102X - Nurse Practitioner Women's Health NM R10019