Healthcare Provider Details

I. General information

NPI: 1811025331
Provider Name (Legal Business Name): RONDA RENEE ANAYA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 CAMEO ST
CLOVIS NM
88101-5571
US

IV. Provider business mailing address

1216 CAMEO ST
CLOVIS NM
88101-5571
US

V. Phone/Fax

Practice location:
  • Phone: 575-763-5583
  • Fax: 575-763-1842
Mailing address:
  • Phone: 575-763-5583
  • Fax: 575-763-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00625
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: