Healthcare Provider Details

I. General information

NPI: 1326902966
Provider Name (Legal Business Name): ANDRIANA DENISE SETHRE FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12305 CONEJO RD NE
ALBUQUERQUE NM
87123-1517
US

IV. Provider business mailing address

12305 CONEJO RD NE
ALBUQUERQUE NM
87123-1517
US

V. Phone/Fax

Practice location:
  • Phone: 701-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69695
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: