Healthcare Provider Details

I. General information

NPI: 1780467886
Provider Name (Legal Business Name): DANA ALLSOP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MUNICIPAL WAY
EDGEWOOD NM
87015-7210
US

IV. Provider business mailing address

7 MUNICIPAL WAY
EDGEWOOD NM
87015-7210
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-3406
  • Fax:
Mailing address:
  • Phone: 505-281-3406
  • Fax: 505-224-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number54228
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54228
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: