Healthcare Provider Details

I. General information

NPI: 1376459990
Provider Name (Legal Business Name): MARANDA L MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

26 ROAD 5151
BLOOMFIELD NM
87413-9700
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2354
  • Fax:
Mailing address:
  • Phone: 505-860-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberR477000
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: