Healthcare Provider Details

I. General information

NPI: 1699162198
Provider Name (Legal Business Name): SARAH LINDIWE HOBONGWANA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HARKLE RD STE B
SANTA FE NM
87505-4753
US

IV. Provider business mailing address

531 HARKLE RD STE B
SANTA FE NM
87505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-8078
  • Fax: 505-207-8078
Mailing address:
  • Phone: 505-207-8078
  • Fax: 505-207-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number57060
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR196063
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR196063
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: