Healthcare Provider Details

I. General information

NPI: 1336003953
Provider Name (Legal Business Name): MEGAN FOUTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

2349 N SUNTUOSO CT
FARMINGTON NM
87401-2188
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2000
  • Fax:
Mailing address:
  • Phone: 254-718-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1216837
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number86656
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: