Healthcare Provider Details

I. General information

NPI: 1558477059
Provider Name (Legal Business Name): ANNA CARUANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S 3RD ST
RATON NM
87740-4005
US

IV. Provider business mailing address

411 S 3RD ST
RATON NM
87740-4005
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-3626
  • Fax: 505-445-8649
Mailing address:
  • Phone: 505-445-3626
  • Fax: 505-445-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR20188
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: