Healthcare Provider Details

I. General information

NPI: 1740587278
Provider Name (Legal Business Name): ELAINE MARIE OGLESBAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE MARIE PAULUS NP

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 IRVING BLVD NW
ALBUQUERQUE NM
87114-5915
US

IV. Provider business mailing address

4420 IRVING BLVD NW
ALBUQUERQUE NM
87114-5915
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-1010
  • Fax: 505-797-4503
Mailing address:
  • Phone: 505-823-1010
  • Fax: 505-797-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-01734
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: