Healthcare Provider Details

I. General information

NPI: 1578224275
Provider Name (Legal Business Name): DANNA KAY LARA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 08/22/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 AVENIDA DE MERCADO
LAS CRUCES NM
88005
US

IV. Provider business mailing address

7600 WATERHOLE CYN
LAS CRUCES NM
88011-8409
US

V. Phone/Fax

Practice location:
  • Phone: 575-224-2552
  • Fax: 575-224-6858
Mailing address:
  • Phone: 940-594-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number66452
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: