Healthcare Provider Details

I. General information

NPI: 1700219623
Provider Name (Legal Business Name): LAURA LEE PAGAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

6901 EASTFORD PL NW
ALBUQUERQUE NM
87114-3687
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-1008
  • Fax:
Mailing address:
  • Phone: 850-316-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: