Healthcare Provider Details

I. General information

NPI: 1639301245
Provider Name (Legal Business Name): LINDA JEAN WIENTJES ACNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD
LAS CRUCES NM
88011-5069
US

IV. Provider business mailing address

2450 S. TELSHORE BLVD.
LAS CRUCES NM
88011-5076
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-5902
  • Fax: 575-521-5033
Mailing address:
  • Phone: 575-556-5902
  • Fax: 575-521-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS-00213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: