Healthcare Provider Details

I. General information

NPI: 1396680591
Provider Name (Legal Business Name): DANIEL STANSBERY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE BLDG 4
ALBUQUERQUE NM
87110-1437
US

IV. Provider business mailing address

14 VIEW DR
CEDAR CREST NM
87008-9714
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-3648
  • Fax:
Mailing address:
  • Phone: 505-228-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN79766
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: