Healthcare Provider Details

I. General information

NPI: 1124724646
Provider Name (Legal Business Name): CLARISSA SILVA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 JACKIE RD SE STE 101
RIO RANCHO NM
87124-1519
US

IV. Provider business mailing address

1350 JACKIE RD SE STE 101
RIO RANCHO NM
87124-1519
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-7518
  • Fax: 505-796-6617
Mailing address:
  • Phone: 505-892-7518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71839
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: