Healthcare Provider Details

I. General information

NPI: 1104041870
Provider Name (Legal Business Name): SANDRA PIEDRA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8443
US

IV. Provider business mailing address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8443
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax: 575-532-8910
Mailing address:
  • Phone: 575-532-8900
  • Fax: 575-532-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR66184
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01454
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: