Healthcare Provider Details

I. General information

NPI: 1316254162
Provider Name (Legal Business Name): THANH-TAM HO CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 LA MIRADA PL NE
ALBUQUERQUE NM
87109-1605
US

IV. Provider business mailing address

PO BOX 25002
ALBUQUERQUE NM
87125-0002
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-0870
  • Fax:
Mailing address:
  • Phone: 505-221-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number01777
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number608
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: