Healthcare Provider Details

I. General information

NPI: 1124955059
Provider Name (Legal Business Name): AMY QUINTANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 JEFFERSON PLZ NE
ALBUQUERQUE NM
87109-3496
US

IV. Provider business mailing address

HC 81 BOX 6018
QUESTA NM
87556
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-3778
  • Fax:
Mailing address:
  • Phone: 575-779-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN53447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: