Healthcare Provider Details

I. General information

NPI: 1639500085
Provider Name (Legal Business Name): MIKHAILE RAMOS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date: 05/13/2022
Reactivation Date: 09/01/2022

III. Provider practice location address

184 UNSER BLVD NE STE B
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

7033 KALGAN RD NE
RIO RANCHO NM
87144-3528
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax:
Mailing address:
  • Phone: 505-800-8344
  • Fax: 818-363-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number68664
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: