Healthcare Provider Details

I. General information

NPI: 1902912413
Provider Name (Legal Business Name): DIANNE C RAND FNP AND LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HIAWATHA DR NE
ALBUQUERQUE NM
87112-1921
US

IV. Provider business mailing address

2449 HIAWATHA DR NE
ALBUQUERQUE NM
87112-1921
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-8212
  • Fax:
Mailing address:
  • Phone: 505-275-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05508
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR09241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: