Healthcare Provider Details

I. General information

NPI: 1093252223
Provider Name (Legal Business Name): ANU GEORGE NEELIYARA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13231 EMERY POINT AVE NE
ALBUQUERQUE NM
87111-8244
US

IV. Provider business mailing address

13231 EMERY POINT AVE NE
ALBUQUERQUE NM
87111-8244
US

V. Phone/Fax

Practice location:
  • Phone: 832-341-8456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: