Healthcare Provider Details

I. General information

NPI: 1679097588
Provider Name (Legal Business Name): LORIE ANN ANDERSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE STE 308
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

2413 FALESCO RD SE
RIO RANCHO NM
87124-8792
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8360
  • Fax: 580-727-8768
Mailing address:
  • Phone: 580-276-6841
  • Fax: 505-727-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71014675A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109536
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55150
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: