Healthcare Provider Details

I. General information

NPI: 1386223014
Provider Name (Legal Business Name): VENUS ROBLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S 8TH ST STE A
DEMING NM
88030-4007
US

IV. Provider business mailing address

1020 S 8TH ST STE A
DEMING NM
88030-4007
US

V. Phone/Fax

Practice location:
  • Phone: 575-936-4350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63218
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: