Healthcare Provider Details

I. General information

NPI: 1013433192
Provider Name (Legal Business Name): MARIA LYNN SPANGLER FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 BAY HILL LOOP SE
RIO RANCHO NM
87124-8211
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-5542
  • Fax:
Mailing address:
  • Phone: 505-923-5362
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03353
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCNP-03353
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: