Healthcare Provider Details

I. General information

NPI: 1073024790
Provider Name (Legal Business Name): MICHELLE AGUIRRE SOTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE SOTO RN

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 HIGHWAY 478
ANTHONY NM
88021-9359
US

IV. Provider business mailing address

PO DRAWER 70
ANTHONY NM
88021
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-3511
  • Fax:
Mailing address:
  • Phone: 575-882-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number917544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: