Healthcare Provider Details

I. General information

NPI: 1871589069
Provider Name (Legal Business Name): LAUREL ANNE STEVENS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SPRUCE ST ESPANOLA HOSPITAL
ESPANOLA NM
87532
US

IV. Provider business mailing address

23 VISTA DEL OCASO RD
RANCHOS DE TAOS NM
87557
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7111
  • Fax:
Mailing address:
  • Phone: 505-737-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR42934
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: