Healthcare Provider Details

I. General information

NPI: 1568018158
Provider Name (Legal Business Name): MOKSHA MARTINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOKSHA BODE APRN

II. Dates (important events)

Enumeration Date: 08/10/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

10909 PASQUALE DR NW
ALBUQUERQUE NM
87114-5576
US

V. Phone/Fax

Practice location:
  • Phone: 907-250-0127
  • Fax:
Mailing address:
  • Phone: 907-250-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number147969
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: