Healthcare Provider Details

I. General information

NPI: 1740651561
Provider Name (Legal Business Name): CARA ROONEY ROSS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 ROCKROSE RD NE
ALBUQUERQUE NM
87122-1115
US

IV. Provider business mailing address

PO BOX 91334
ALBUQUERQUE NM
87199-1334
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-1645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02740
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02740
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: