Healthcare Provider Details

I. General information

NPI: 1447643002
Provider Name (Legal Business Name): RHONDA WILLIS PAGE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EL PASEO RD
LAS CRUCES NM
88001-6013
US

IV. Provider business mailing address

1605 EL PASEO RD
LAS CRUCES NM
88001-6013
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-5400
  • Fax: 575-524-5301
Mailing address:
  • Phone: 575-523-5400
  • Fax: 575-523-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: