Healthcare Provider Details

I. General information

NPI: 1265965362
Provider Name (Legal Business Name): MIA NICOLE SAENZ DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 S TELSHOR BLVD
LAS CRUCES NM
88011-5029
US

IV. Provider business mailing address

1008 LOS MOROS DR
EL PASO TX
79932-1831
US

V. Phone/Fax

Practice location:
  • Phone: 755-227-7985
  • Fax: 575-522-3416
Mailing address:
  • Phone: 575-202-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03200
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: