Healthcare Provider Details

I. General information

NPI: 1811493984
Provider Name (Legal Business Name): ANNA ELISABETH PRAAMSMA MSN, CPNP-PC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DON PASQUAL RD NW
LOS LUNAS NM
87031-8841
US

IV. Provider business mailing address

145 DON PASQUAL RD NW
LOS LUNAS NM
87031-8841
US

V. Phone/Fax

Practice location:
  • Phone: 505-241-5182
  • Fax:
Mailing address:
  • Phone: 616-540-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704308948
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704308948
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number65707
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: