Healthcare Provider Details

I. General information

NPI: 1154957413
Provider Name (Legal Business Name): LUANNE M GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1727
US

IV. Provider business mailing address

1014 CEDARDALE DR
LAS CRUCES NM
88005-0901
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4400
  • Fax:
Mailing address:
  • Phone: 575-644-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58294
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: