Healthcare Provider Details

I. General information

NPI: 1609329838
Provider Name (Legal Business Name): LORENA J. STOVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2559 MEDICAL DR STE D
ALAMOGORDO NM
88310-8704
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-6900
  • Fax:
Mailing address:
  • Phone: 575-434-2229
  • Fax: 575-439-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03164
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: