Healthcare Provider Details

I. General information

NPI: 1215696588
Provider Name (Legal Business Name): JESSICA ELIZABETH ALTAMIRANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 S DON ROSER DR
LAS CRUCES NM
88011-9107
US

IV. Provider business mailing address

4729 ZACHARY LN
LAS CRUCES NM
88012-5080
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7880
  • Fax:
Mailing address:
  • Phone: 575-494-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66320
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: