Healthcare Provider Details

I. General information

NPI: 1588355721
Provider Name (Legal Business Name): JENNIFER LYNN CASTANEDA-LOVATO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE ROAD 571 BLD 28
EL RITO NM
87530
US

IV. Provider business mailing address

PO BOX 237
EL RITO NM
87530-0237
US

V. Phone/Fax

Practice location:
  • Phone: 575-581-4728
  • Fax:
Mailing address:
  • Phone: 575-581-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number73502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: