Healthcare Provider Details

I. General information

NPI: 1467260547
Provider Name (Legal Business Name): RESILIENCE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 SPITZ ST
LAS CRUCES NM
88005-1213
US

IV. Provider business mailing address

3595 SPITZ ST
LAS CRUCES NM
88005-1213
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-0957
  • Fax:
Mailing address:
  • Phone: 575-654-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PRYOR
Title or Position: PRESIDENT
Credential: DNP
Phone: 575-654-0957