Healthcare Provider Details

I. General information

NPI: 1285866483
Provider Name (Legal Business Name): SAMANTHA ENDRES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

6100 PAN AMERICAN FWY NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8888
  • Fax:
Mailing address:
  • Phone: 505-823-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number91774
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: