Healthcare Provider Details

I. General information

NPI: 1912091307
Provider Name (Legal Business Name): DIANNA SEARS CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE PRESBYTERIAN HOSPITAL NICU
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-810-1090
  • Fax: 505-222-2371
Mailing address:
  • Phone: 505-923-5356
  • Fax: 505-923-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR22065
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberCNP00374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: