Healthcare Provider Details

I. General information

NPI: 1437526514
Provider Name (Legal Business Name): EMILY LAURA CANCELLARE-WELCH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2884 N ROADRUNNER PKWY
LAS CRUCES NM
88011-0853
US

IV. Provider business mailing address

PO BOX 74008272
CHICAGO IL
60674-8272
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax: 702-977-1496
Mailing address:
  • Phone: 702-977-1496
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2026-0107
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: