Healthcare Provider Details

I. General information

NPI: 1811048283
Provider Name (Legal Business Name): DEBRA SICKLER-HART CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2914
US

IV. Provider business mailing address

2815 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2914
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-9229
  • Fax:
Mailing address:
  • Phone: 505-345-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR18805
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: