MEDICARE: EVA ROSE ASAAN CARRILLO CNM, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	80143	NM
2	176B00000X	Midwife	727	NM

General Provider Information

NPI Number	:	1881135416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA ROSE ASAAN CARRILLO CNM, FNP-C

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 LOMAS BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2719
Country	:	US
Telephone Number	:	505-272-4155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/29/2026

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