Healthcare Provider Details

I. General information

NPI: 1013273325
Provider Name (Legal Business Name): MAXINE ROSE HORTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAXINE ROSE IGER

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

IV. Provider business mailing address

719 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9511
  • Fax: 505-268-4653
Mailing address:
  • Phone: 505-944-2021
  • Fax: 505-266-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP-01920
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0990300-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: