Healthcare Provider Details

I. General information

NPI: 1114723491
Provider Name (Legal Business Name): LIBNI SIMEI PEREZ LUIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

1648 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-0085
  • Fax:
Mailing address:
  • Phone: 505-585-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: