Healthcare Provider Details

I. General information

NPI: 1598089344
Provider Name (Legal Business Name): SAMANTHA RUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 STELZER DR NE
RIO RANCHO NM
87144-7063
US

IV. Provider business mailing address

4122 STELZER DR NE
RIO RANCHO NM
87144-7063
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-0860
  • Fax: 505-808-4966
Mailing address:
  • Phone: 505-553-0860
  • Fax: 505-808-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: