Healthcare Provider Details

I. General information

NPI: 1245061449
Provider Name (Legal Business Name): ANNA HORNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE H160
ALBUQUERQUE NM
87104-2063
US

IV. Provider business mailing address

314 12TH ST SW
ALBUQUERQUE NM
87102-2812
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-0807
  • Fax:
Mailing address:
  • Phone: 651-269-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: