Healthcare Provider Details

I. General information

NPI: 1871813246
Provider Name (Legal Business Name): RUTH E. ROMO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 N ALAMEDA BLVD SUITE 14
LAS CRUCES NM
88005-2194
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-1100
  • Fax: 575-522-0100
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01626
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: