Healthcare Provider Details

I. General information

NPI: 1790453793
Provider Name (Legal Business Name): MONICA ARENCON-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4450
US

IV. Provider business mailing address

7007 JEFFERSON ST NE STE C
ALBUQUERQUE NM
87109-4450
US

V. Phone/Fax

Practice location:
  • Phone: 505-340-0406
  • Fax:
Mailing address:
  • Phone: 505-340-0406
  • Fax: 505-340-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65039
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number65039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: