Healthcare Provider Details

I. General information

NPI: 1861428344
Provider Name (Legal Business Name): ELIZABETH A DONIGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S 8TH ST STE B
DEMING NM
88030-4037
US

IV. Provider business mailing address

1413 COLUMBUS RD
DEMING NM
88030-5251
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-7200
  • Fax: 575-546-6540
Mailing address:
  • Phone: 575-546-6548
  • Fax: 575-546-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 9216691
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR66903
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP007054
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP01470
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: