Healthcare Provider Details

I. General information

NPI: 1750666327
Provider Name (Legal Business Name): CYNTHIA JOANNA WOOTEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY SUITE D
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY SUITE D
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-325-9113
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-325-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP-01835
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: