Healthcare Provider Details

I. General information

NPI: 1316671803
Provider Name (Legal Business Name): MERYSA SANCHEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERYSA AVITIA

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE WLTC 4-ACC
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

2211 LOMAS BLVD NE WLTC 4-ACC
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2245
  • Fax: 505-272-1109
Mailing address:
  • Phone: 505-272-2245
  • Fax: 505-272-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number68278
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: