Healthcare Provider Details

I. General information

NPI: 1245069731
Provider Name (Legal Business Name): ANNALEE MUNDY PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E IDAHO AVE STE 3
LAS CRUCES NM
88005-3241
US

IV. Provider business mailing address

412 CONWAY AVE
LAS CRUCES NM
88005-7712
US

V. Phone/Fax

Practice location:
  • Phone: 575-571-4390
  • Fax:
Mailing address:
  • Phone: 575-993-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-0520
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: