Healthcare Provider Details

I. General information

NPI: 1285506360
Provider Name (Legal Business Name): DIETTA DAWN LENCE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35282 HWY 285
OJO CALIENTE NM
87549
US

IV. Provider business mailing address

1922 AVENIDA CANADA
ESPANOLA NM
87532-2901
US

V. Phone/Fax

Practice location:
  • Phone: 505-583-2191
  • Fax:
Mailing address:
  • Phone: 270-564-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86425
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: