Healthcare Provider Details

I. General information

NPI: 1366911596
Provider Name (Legal Business Name): DENISE PORTELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4383
US

IV. Provider business mailing address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4383
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-1458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-83423
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN-83423
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: