Healthcare Provider Details

I. General information

NPI: 1043596067
Provider Name (Legal Business Name): HERLINDA MAGILL PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE A
LAS CRUCES NM
88001-3117
US

IV. Provider business mailing address

1990 E LOHMAN AVE STE A
LAS CRUCES NM
88001-3117
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-4602
  • Fax:
Mailing address:
  • Phone: 575-522-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR50261
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS00195
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number68336
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: