Healthcare Provider Details

I. General information

NPI: 1962823914
Provider Name (Legal Business Name): BRANDI GORZEMAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

PO BOX 2845
LAS CRUCES NM
88004-2845
US

V. Phone/Fax

Practice location:
  • Phone: 575-303-2929
  • Fax: 752-336-2605
Mailing address:
  • Phone: 575-303-2929
  • Fax: 575-233-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number74019
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR41405
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: