Healthcare Provider Details

I. General information

NPI: 1689557282
Provider Name (Legal Business Name): AMANDA ROMERO-MONTANO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 RIDGE RUNNER RD
LAS VEGAS NM
87701-4972
US

IV. Provider business mailing address

117 CAMINO DE VIDA STE 300
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-434-0119
  • Fax: 877-553-1272
Mailing address:
  • Phone: 575-472-4311
  • Fax: 877-651-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-85222
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: