Healthcare Provider Details

I. General information

NPI: 1699755140
Provider Name (Legal Business Name): SANDRA ANN GALE RN, CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO MSC11 6145
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

906 VALVERDE DR SE
ALBUQUERQUE NM
87108-3472
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4462
  • Fax:
Mailing address:
  • Phone: 505-263-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR15455
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberCNP00168
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: