Healthcare Provider Details

I. General information

NPI: 1700343696
Provider Name (Legal Business Name): TRINA MARIE SEIFERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINA MARIE JENSEN

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST NW STE M
LOS LUNAS NM
87031-4866
US

IV. Provider business mailing address

1400 MAIN ST NW STE M
LOS LUNAS NM
87031-4866
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-0533
  • Fax: 505-916-0869
Mailing address:
  • Phone: 505-916-0533
  • Fax: 505-916-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55328
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: