Healthcare Provider Details

I. General information

NPI: 1841174042
Provider Name (Legal Business Name): BRITTANY WILLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIN PUEBLO RD
ALGODONES NM
87001-7002
US

IV. Provider business mailing address

3210 SUE CIR SE
RIO RANCHO NM
87124-2048
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-7350
  • Fax:
Mailing address:
  • Phone: 505-400-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84756
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: