Healthcare Provider Details

I. General information

NPI: 1215261946
Provider Name (Legal Business Name): UNIVERSITY OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841B HIGHWAY 66
EDGEWOOD NM
87015-9104
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO MSC 09 5350
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-3100
  • Fax: 505-286-3102
Mailing address:
  • Phone: 505-272-6284
  • Fax: 505-272-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY RIDENOUR
Title or Position: DEAN UNM COLLEGE OF NURSING
Credential: A.P.R.N., PHD
Phone: 505-272-6284