Healthcare Provider Details

I. General information

NPI: 1346797453
Provider Name (Legal Business Name): ELIZABETH FOGEL APRN-CNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/30/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 CASA BONITA DR NE
ALBUQUERQUE NM
87111-5607
US

IV. Provider business mailing address

3129 CASA BONITA DR NE
ALBUQUERQUE NM
87111-5607
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-6665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65228
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: