Healthcare Provider Details

I. General information

NPI: 1376432211
Provider Name (Legal Business Name): EMMA LIZETTE PEOBLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

3301 LUNA DR
LAS VEGAS NM
87701-9774
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax:
Mailing address:
  • Phone: 725-400-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: