Healthcare Provider Details

I. General information

NPI: 1215941380
Provider Name (Legal Business Name): PATRICIA ANNE WHITMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 WILEY AVE
LAS CRUCES NM
88007-5971
US

IV. Provider business mailing address

1044 WILEY AVE
LAS CRUCES NM
88007-5971
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-3664
  • Fax: 575-652-4525
Mailing address:
  • Phone: 575-520-3664
  • Fax: 575-652-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR43983
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01034
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: