Healthcare Provider Details

I. General information

NPI: 1700330560
Provider Name (Legal Business Name): MARISSA D CORTES MENDEZ CNM, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BOTULPH LN
SANTA FE NM
87505-6912
US

IV. Provider business mailing address

401 BOTULPH LN
SANTA FE NM
87505-6912
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8387
  • Fax:
Mailing address:
  • Phone: 505-983-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03001
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number709
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: