Healthcare Provider Details

I. General information

NPI: 1962012096
Provider Name (Legal Business Name): DONNA LEE RODARTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

PO BOX 865
SPRINGER NM
87747-0865
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax:
Mailing address:
  • Phone: 832-344-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP89158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: