Healthcare Provider Details

I. General information

NPI: 1013104504
Provider Name (Legal Business Name): MARJORIE CYPRESS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7455
  • Fax: 505-262-3955
Mailing address:
  • Phone: 505-262-7455
  • Fax: 505-262-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR35250
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: