Healthcare Provider Details

I. General information

NPI: 1003400680
Provider Name (Legal Business Name): EDNA R ZAPATA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST STE A1
CLOVIS NM
88101-4092
US

IV. Provider business mailing address

2000 W 21ST ST STE A1
CLOVIS NM
88101-4092
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-8055
  • Fax: 575-723-3351
Mailing address:
  • Phone: 575-762-8055
  • Fax: 575-763-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: