Healthcare Provider Details

I. General information

NPI: 1619177599
Provider Name (Legal Business Name): MARGARET VANANTWERP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ELLIOTT BARKER
ANGEL FIRE NM
87710
US

IV. Provider business mailing address

11 ELLIOTT BARKER
ANGEL FIRE NM
87710
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-3301
  • Fax: 575-377-3991
Mailing address:
  • Phone: 505-377-3301
  • Fax: 575-377-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR60851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: