Healthcare Provider Details

I. General information

NPI: 1215408497
Provider Name (Legal Business Name): AANU OGUNBANJO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberAP138417
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54954
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: