Healthcare Provider Details

I. General information

NPI: 1700269271
Provider Name (Legal Business Name): EDUARD SCHANDER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N PEARL ST
DEMING NM
88030-3835
US

IV. Provider business mailing address

111 N PEARL ST
DEMING NM
88030-3835
US

V. Phone/Fax

Practice location:
  • Phone: 575-517-2725
  • Fax: 575-517-2280
Mailing address:
  • Phone: 575-517-2725
  • Fax: 575-517-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03318
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: