Healthcare Provider Details

I. General information

NPI: 1972427532
Provider Name (Legal Business Name): HOLLY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W AZTEC BLVD
AZTEC NM
87410-1800
US

IV. Provider business mailing address

1118 W AZTEC BLVD
AZTEC NM
87410-1800
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-9474
  • Fax: 505-599-4388
Mailing address:
  • Phone: 505-334-9474
  • Fax: 505-599-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number80630
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: