Healthcare Provider Details

I. General information

NPI: 1295863892
Provider Name (Legal Business Name): ANITA BRISCOE APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 ADAMS ST NE
ALBUQUERQUE NM
87110-6224
US

IV. Provider business mailing address

718 ADAMS ST NE
ALBUQUERQUE NM
87110-6224
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-9495
  • Fax:
Mailing address:
  • Phone: 505-720-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR-16266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: