Healthcare Provider Details

I. General information

NPI: 1902227127
Provider Name (Legal Business Name): REBECCA L ELLIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L DONALDSON RN

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 03/28/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N MOTEL BLVD
LAS CRUCES NM
88007-4100
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-5941
  • Fax: 575-541-5048
Mailing address:
  • Phone: 575-267-3088
  • Fax: 575-267-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR66850
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: