Healthcare Provider Details

I. General information

NPI: 1811980642
Provider Name (Legal Business Name): MARSHA SOUERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

14 CALLE LAGARTIJAS
PLACITAS NM
87043-9504
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax: 505-265-7045
Mailing address:
  • Phone: 505-771-8071
  • Fax: 505-771-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR54597
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: