Healthcare Provider Details

I. General information

NPI: 1184294431
Provider Name (Legal Business Name): JORDAN LEMAY ZILAVY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

1252 ROSEMONT AVE NW
ALBUQUERQUE NM
87104-2175
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2715
  • Fax:
Mailing address:
  • Phone: 417-463-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number64188
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: