Healthcare Provider Details

I. General information

NPI: 1588894505
Provider Name (Legal Business Name): CYNTHIA L PRIOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA L HALL RN

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION NE BUILDING D
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

8300 CONSTITUTION NE BUILDING D
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2100
  • Fax: 505-291-2102
Mailing address:
  • Phone: 505-291-2100
  • Fax: 505-291-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR19700
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: