Healthcare Provider Details

I. General information

NPI: 1679655955
Provider Name (Legal Business Name): PILAR MARIE ANLLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR SUITE 400
SANTA FE NM
87505-4769
US

IV. Provider business mailing address

1650 HOSPITAL DR SUITE 400
SANTA FE NM
87505-4769
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-1975
  • Fax: 505-467-8666
Mailing address:
  • Phone: 505-989-1975
  • Fax: 505-467-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR28099
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: